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C&e  Hiorarp 

Of  tJ)f 

Dit)t0ion  of  l£>ealt&  affairs 
CJntoersitp  of  Ji3ottfj  Carolina 


This  Book  Must  Not  Be  Taken 
from  the  Division  of   Health 

Affairs  Buildings. 

FOUR   DAYSc 

This  JOURNAL  may  be  kept  ouUTWO  DAYS, 
and  is  subject  to  a  fine  of  FIVE  fc&IVr*S*day 
thereafter.  It  is  DUE  on  the  DAY  indicated 
below: 


NORTH  CAROLINA  MEDICAL  JOURNAL 

Owned  and  Published  by 

THE  MEDICAL  SOCIETY  OF  THE  STATE  OF  NORTH  CAROLINA 

Under  the  Direction  of  Its 


EDITORIAL  BOARD 


Wingate  M.  Johnson,  M.D. 

Winston-Salem,  Editor 

Mr.  James  T.  Barnes 

Raleigh,  Business  Manager 

G.  Westbrook  Murphy,  M.D. 

Asheville,  Chairman 

Ernest  W.  Furgurson,  M.D. 

Plymouth 


John  Borden  Graham,  M.D. 

Chapel  Hill 

William  M.  Nicholson,  M.D. 

Durham 

Robert  W.  Prichard,  M.D. 

Winston-Salem 

Charles  W.  Styron,  M.D. 

Raleigh 


Miss  Louise  MacMillan 

Winston-Salem,  Assistant  Editor 


VOLUME  21 


JANUARY-DECEMBER,   1960 


300  South  Hawthorne  Road 


EDITORIAL  OFFICE 


Winston-Salem   7,   N.  C. 


Press  of 

CARMICHAEL  PRINTING  COMPANY 


1309  Hawthorne  Road,  SW 


Winston-Salem,  N.  C. 


-T 


Digitized  by  the  Internet  Archive 

in  2011  with  funding  from 

North  Carolina  History  of  Health  Digital  Collection,  an  LSTA-funded  NC  ECHO  digitization  grant  project 


http://www.archive.org/details/ncarolinamed2121960medi 


NORTH  CAROLINA 


IN  THIS  ISSUE: 

THE  PRESIDENT'S  INAUGURAL  ADDRESS 
—  AMOS  N.  JOHNSON,  M.D.  — 


N£     3 


Surfadil 

thycaine  and  thenylpyramir.e,  Lilly) 

SHIELDS 

SENSITIVE 

SKIN 


Each  100  cc.  of  Lotion  Surfadil  provide: 

local 
antihistamine    .     .    Histadyl*  ...       2  Gm. 

topical  anesthetic     .    Surfacaine*    .    .    0.5  Gm. 

adsorptive  and 

protective  cover     Titanium  Dioxide  .  5  Gm. 

The  Surfadil  coating  also  acts  as  a  translucent 
"shield"  to  deflect  the  sun's  rays. 

Available  in  spillproof.   unbreakable  plastic 
containers  of  75  cc.  and  in  pint  bottles. 


Hisladyl®  (thenylpyramine.  Lilly) 
Surfacatne®  (cyclomethycaine,  Lilly) 


ELI   LILLY  AND  COMPANY  •    INDIANAPOLIS  6,  INDIANA,  U.  S.  A. 


STm, 

Table  of  Contents,  Page  II 


CLINICAL  REMISSION 

IN  A  "PROBLEM"  ARTHRITIC 

In  "escaping"  rheumatoid  arthritis.  After  gradually  "escaping"  the  ther- 
apeutic effects  of  other  steroids,  a  52-year-old  accountant  with  ar- 
thritis for  five  years  was  started  on  Decadron.  1  mg. /day.  Ten  months 
later,  still  on  the  same  dosage  of  Decadron,  weight  remains  constant, 
she  has  lost  no  time  from  work,  and  has  had  no  untoward  effects.  She 
is  in  clinical  remission.* 

New  convenient  b.  i.  d.  alternate  dosage  schedule:  the  degree  and  extent  of  relief  provided  by 
DECADRON  allows  for  b.i.d.  maintenance  dosage  in  many  patients  with  so-called  "chronic"  condi- 
tions. Acute  manifestations  should  first  be  brought  under  control  with  a  t.i.d.  or  q.i.d.  schedule. 

Supplied:  As  0.75  mg.  and  0.5  mg.  scored,  pentagon-shaped  tablets  in  bottles  of  100.  Also  available 
as  Injection  DECADRON  Phosphate.  Additional  information  on  DECADRON  is  available  to  physicians 
on  request.  DECADRON  is  a  trademark  of  Merck  &  Co..  inc. 

'From  a  clinical  investigator's  report  to  Merck  Sharp  &  Dohme. 


Decadron 


Dexamethasone 


TREATS  MORE  PATIENTS  MORE  EFFECTIVELY 

&3m  MERCK  SHARP  &  DOHME  •  Division  of  Merck  &  Co.,  Inc.,  West  Point,  Pa. 


■    ,. 


•f.* 


/ 


.T= 


SK- 


A\ 


l  n 


f$ii£ 


July,  1960 


ADVERTISEMENTS 


A  Sanitarium  for  Rest   Under  Medical   Supervision,  and  Treatment  of  Nervous 
and  Mental  Diseases,  Alcoholism  and  Drug  Addiction. 

The  Pinebluff  Sanitarium  is  situated  in  the  sandhills  of  North  Carolina  in  a  60-acre  park 
of  long  pines.  It  is  located  on  U.  S.  Route  1,  six  miles  south  of  Pinehurst  and  Southern 
Pines.    This    section    is    unexcelled    for    its    healthful    climate. 

Ample  facilities  are  afforded  for  recreational  and  occupational  therapy,  particularly  out- 
of-doors. 

Special  stress  is  laid  on  psychotherapy.  An  effort  is  made  to  help  the  patient  arrive  at 
an  understanding  of  his  problems  and  by  adjustment  to  his  personality  difficulties  or 
modification  of  personality  traits  to  effect  a  cure  or  improvement  in  the  disease.  Two  resident 
physicians    and    a    limited    number    of    patients    afford    individual    treatment    in    each    case. 

For    further    information    write: 

The  Pineblu££  Sanitarium,  Pinebluff,  N.  c. 


Malcolm  D.  Kemp,  M.D. 


Medical  Director 


WELCH  ALLYN  RECTAL  SETS 

Welch  Allyn  distally  illuminated  proctoscopes 
and  sigmoidoscopes  are  designed  to  meet  every 
requirement  for  thorough  rectal  examination 
and  treatment.  Abundant  illumination  is  pro- 
vided directly  at  the  area  under  observation  and 
an  unobstructed  view  for  diagnosis  is  assured 
through  the  use  of  a  small,  powerful  Welch 
Allyn  "Bright  Light"  lamp.  The  outer  tube  is 
calibrated  in  centimeters  and  the  inner  tube  is 
optically  designed  to  reduce  the  annoying  glare 
usually  found  in  this  type  instrument.  The 
obturator  tip  is  tapered  and  curved  in  an  an- 
atomically correct  manner  to  facilitate  the 
passage  of  the  instrument  through  the  sphincter 
muscle  and  by  the  prostate  gland  region.  Ideally 
designed  for  use  with  No.  343  biopsy  punch. 

No.   314     No.   300   proctoscope   and   No.   308   sigmoidoscope  with  inflating  bulb  and  No.  725  cord, 
in   case   as   illustrated    $73.50 

No.    343    BIOPSY    PUNCH    not   illustrated S66.00 


WINCHESTER 

"CAROLINAS'    HOUSE    OF    SERVICE" 


WINCHESTER   SURGIICAL   SUPPLY   CO. 
119  East  7th  Street  Charlotte,   N.   C. 


WINCHESTER-RITCH    SURGICAL    CO. 

421  West  Smith  St.       Greensboro,  N.  C. 


II 


NORTH  CAROLINA   MEDICAL  JOURNAL 


July,  1960 


North  Carolina  Medical  Journal 

Official  Organ  of 
The  Medical  Society  of  the  State  of  North  Carolina 


Volume   21 
Number    7 


JULY,  1960 


76    CENTS     A    COPY 
$5.00     A    YEAR 


CONTENT 


Original  Articles 


President's      Inaugural 
Johnson,    M.D.     .     . 


Address  —  Amos      N. 


261 


Bad   Politics   and   Good   Medicine   Don't   Mix- 
Louis    M    Orr,    M.D 


264 


Three  Great  Challenges — Leonard  W.  Larson, 
M.D 267 

Generalized  Salivary  Gland  Virus  Disease  in 
Postneonatal  Life  —  Charles  F.  Gilbert, 
M.D 270 

Antibiotic  Resistant  Pulmonary  Staphylococ- 
cic  Infections— George   L.    Calvy,   MC,   USN     275 

Some  Facts  About  Nursing  in  North  Carolina 
—Vivian    M.    Culver 279 


A  Rural  Home  Care  Program — C.  David  Gar- 
vin,   M.D.,    M.P.H 282 

Report  on  Actions  of  the  House  of  Delegates, 
American  Medical  Association,  One  Hun- 
dredth Ninth  Annual  Meeting — F.  J.  L. 
Blasingham,    M.D 285 


CORRESPONDENCE 

Biennial   Registration   Act — J.   R.   Gamble,  Jr., 
M.D 

COMMITTEES  AND  ORGANIZATIONS 

Schedule   of   Committee    and    Commission    Ap- 
pointments,    1960-1961 


292 


293 


Bulletin  Board 

Coming    Meetings        

News   Notes  from   the   Duke   University   Med- 
ical   Center 

News    Notes    from    the    University    of    North 
Carolina    School    of    Medicine 

News    Notes    from    the    Bowman    Gray    School 
of  Medicine   of  Wake   Forest  College   .     .     . 

County     Societies 

News     Notes        

Announcements        

The  Month  in  Washington 

308 


300 
301 
302 


303 
304 
304 

305 


Editorials 

The    A.M.A.'s     One     Hundred     Ninth     Annual 

Meeting        289 

The   Old    Order   Changeth 289 

"Symptomatic     Medicine" 290 

Nurses    and    Nursing 291 

Medical     Prepayment    and     Our     Social    Philo- 
sophy         291 


Book  Reviews 

309 

In  Memoriam 

312 

Classified  Advertisements 

308 

Index  to  Advertisers 
lxiii 


Entered    as    second-class    matter    January    2.    1940,    at    the    Post   Office   at   Winston-Salem.    North    Carolina,    under    the    Act    of 
August  24,   1912.  Copyright   1960  by  the   Medical  Society  of   the  State  of   North   Carolina. 


17 


-202 


tL'cka-l  Letter  SpinTEi^IT 
«  Shown  Below 


rolin 


idics" 


>F   CHLORAL   HYDRATE 


"kry  will  di«. 
"dtbi,  column 


T,'\  -Dec, 

I960 


11 


WoodeD 


4838 


able  chloral  hydrate  syrup 


containing  10  grains  in  each  teaspoonful. 


JONES  and  VAUGHAN 
Richmond  26,  Virginia 


■ 


■    ■■■*'■ 


A  most  appetizing  help  for 
patients  where  a  cholesterol 
depressant  diet  is  prescribed 


Wesson's  Chicken  Cook  Book 

FREE  in  quantities 

for  your  distribution  to  patients 


Wesson 

.. 

for  Frying 
^kirtg  and  Sala* 

Iftfe 

UTm] 

The  enticing  variety  of  dishes  offered  in  "101  Glorious  Ways  to 
Cook  Chicken"  can  help  make  a  restricted  regimen  less  monotonous 
and  encourages  the  patient's  compliance  with  it. 

The  high  poly-unsaturated  fat  content  of  poultry— prepared  in 
poly-unsaturated  Wesson — makes  it  a  special  help  to  those  on 
cholesterol  depressant  diets.  Happily,  too,  chicken  is  moderate  in 
calories,  universally  popular  and  one  of  the  most  economical 
protein  foods  in  the  grocery  today. 

Recipes  for  Chicken  Rosemary,  Sesame,  Jambalaya,  Pilaf,  etc., 
teach  scores  of  new  ways  to  enhance  chicken  with  herbs  and 
spices,  new  combinations  with  fruits  and  vegetables,  how  to  use 
sauces  and  seasonings  wisely  and  well.  Careful  consideration  has 
been  given  to  the  choice  of  ingredients  to  keep  saturated  fats 
to  a  minimum. 

Where  a  vegetable  (salad)  oil  is  medically 

recommended  for  a  cholesterol  depressant  regimen, 
Wesson  is  unsurpassed  by  any  readily  available  brand. 


1^%  jf& 


HICKEN  SESAME — with  its  crunchy  nutlike  flavor  from  the  Indies — is  typical  of  the  glorious  eating  contained  in  this  new  Wesson  cook  book. 


WESSON'S     IMPORTANT     CONSTITUENTS 

Wesson  is  100%  cottonseed  oil . . . 
winterized  and  of  selected  quality 

inoleic  acid  glycendes  (poly-unsaturated)  50-55  % 

Jleic  acid  glycerides  (mono-unsaturated)  16-20% 

otal  unsaturated  70-75% 

'almitic,  stearic  and  myristic  glycerides  (saturated)  25-30% 

'hytosterol  (predominantly  beta  sitosterol)  0.3-0.5% 

Total  tocopherols  0.09-0.12% 

Never  hydrogenated— completely  salt  free 

Each  pint  of  Wesson  contains  437-524  Int.  Units  of  Vitamin  E 


Send  coupon  for  quantity  needed  for  your  patients. 

The  Wesson  People,  210  Baronne  Street, 
New  Orleans  12,  La. 

Please  send    me   .  .   .   free   copies  of  the   Wesson   cook   book 
"101   Glorious  Ways  to   Cook   Chicken." 


Name. . 
Address 
City.... 


.Zone. 


.State. 


VI  NORTH   CAROLINA   MEDICAL  JOURNAL  July.  1960 


Proven 

in  over  five  years  of  clinical  use  and 
more  than  750  published  clinical  studies 

Effective 

for  relief  of  anxiety  and  tension 

Outstandingly  Safe 

•  simple  dosage  schedule  produces  rapid,  reliable 
tranquilization  without  unpredictable  excitation 

•  no  cumulative  effects,  thus  no  need  for  difficult 
dosage  readjustments 

•  does  not  produce  ataxia,  change  in  appetite  or  libido 

•  does  not  produce  depression,  Parkinson-like  symptoms, 
jaundice  or  agranulocytosis 

•  does  not  impair  mental  efficiency  or  normal  behavior 


for 
the 

tense 
and 
nervous 
patient 


Despite  the  introduction  in  recent  years  of  "new  and  dif- 
ferent" tranquilizers,  Miltown  continues,  quietly  and 
steadfastly,  to  gain  in  acceptance.  Generically  and  under 
the  various  brand  names  by  which  it  is  distributed, 
meprobamate  ( Miltown  I  is  prescribed  by  the  medical 
profession  more  than  any  other  tranquilizer  in  the  world. 

The  reasons  are  not  hard  to  find.  Miltown  is  a  known  drug, 
evaluated  in  more  than  750  published  clinical  reports.  Its 
few  side  effects  have  been  fully  reported;  there  are  no 
surprises  in  store  for  either  the  patient  or  the  physician. 
It  can  be  relied  upon  to  calm  anxiety  and  tension  quickly 
and  predictably. 


Usual  dosage :  One  or  two 
400  mg.  tablets  t.i.d. 
Supplied:  400  mg.  scored  tablets, 
200  mg.  sugar-coated  tablets; 
or  as  meprotabs*-400  mg. 
unmarked,  coated  tablets. 


Miltown 


meprobamate  (Wallace) 


'  WALLACE  LABORATORIES  /  New  Brunsivick,  N.  J. 
V*" 


July,  1960  ADVERTISEMENTS VII 


when  that  early  Monday  morning  telephone 
call  is  from  a  weekend  do-it-yourselfer 

". . .  and  this  morning,  Doctor,  my  back 
is  so  stiff  and  sore  I  can  hardly  move." 

now. . .  there  is  a  way  to  prompt,  dependable 
relief  of  back  distress 

the  pain  goes  while  the  muscle  relaxes 


POTENT  —rapid  relief  in  acute  conditions 
SAFE  —  for  prolonged  use  in  chronic  conditions 

notable  safety —  extremely  low  toxicity;  no  known 
contraindications;  side  effects  are  rare; 
drowsiness  may  occur,  usually  at  higher  dosages 

rapid  action,  sustained  effect  —starts  to  act 
quickly,  relief  lasts  up  to  6  hours 

easy  to  use  — usual  adult  dosage  is  one  350  mg. 
tablet  3  times  daily  and  at  bedtime 

supplied -as  350  mg.,  white,  coated  tablets, 
bottles  of  50;  also  available  for  pediatric  use: 
250  mg.,  orange  capsules,  bottles  of  50 

VAy  WALLACE  LABORATORIES,  New  Brunswick,  New  Jersey 


(CARISOPRODOL   WALLACE) 


VIII NORTH  CAROLINA  MEDICAL  JOURNAL July,  1960 

Medical  Society  of  the  State  of  North  Carolina 

OFFICERS  —  1960 

President — Amos  Neill  Johnson,  M.D.,  Garland 

President  Elect — Claude  B.  Squires,  M.D.,  225  Hawthorne  Lane,  Charlotte 
Past.  President — John  C.  Reece,  M.D.,  Grace  Hospital,  Morganton 
First  Vice-President — Theodore  S.  Raiford,  M.D.,  Doctors  Building,  Asheville 
Second  Vice-President — Charles  T.  Wilkinson,  M.D.,  Wake  Forest 
Secretary — John  S.  Rhodes,  M.D.,  700  West  Morgan  Street,  Raleigh 
Executive  Director — Mr.  James  T.  Barnes,  203  Capital  Club  Building,  Raleigh 
The   President,   Secretary   and   Executive   Director  are  members   ex-officio 

of  all  committees 
Speaker-House  of  Delegates — Donald  B.  Koonce,  M.D.,  408  N.   11th  St.,  Wilmington 
Vice-Speaker-House  of  Delegates — E.  W.  Schoenheit,  M.D.,  46  Haywood  St.,  Asheville 


COUNCILORS  —  1958  -  1961 

First  District— T.  P.  Brinn,  M.D.,  118  W.  Market  Street,  Hertford 

Vice  Councilor — Q.  E.  Cooke,  M.D.,  Murfreesboro 
Second  District — Lynwood  E.  Williams,  M.D.,  Kinston  Clinic,  Kinston 

Vice  Councilor — Ernest  W.  Larkin,  Jr.,  M.D.,  211  N.  Market  St.,  Washington 
Third  District — Dewey  H.  Bridger,  M.D.,  Bladenboro 

Vice  Councilor — William  A.  Greene,  M.D.,  104  E.  Commerce  St.,  Whiteville 
Fourth  District — Edgar  T.  Beddingfield,  Jr.,  M.D.,  P.O.  Box  137,  Stantonsburg 

Vice  Councilor — Donnie  H.  Jones,  M.D.,  Box  67,  Princeton 
Fifth  District — Ralph  B.  Garrison,  M.D.,  222  N.  Main  Street,  Hamlet 

Vice  Councilor — Harold  A.  Peck,  M.D.,  Moore  County  Hospital,  Pinehurst 
Sixth  District — George  W.  Paschal,  Jr.,  M.D.,  1110  Wake  Forest  Rd.,  Raleigh 

Vice  Councilor— Rives  W.  Taylor,  M.D.,  P.O.  Box  1191,  Oxford 

Seventh  District — 

Vice  Councilor — Edward  S.  Bivens,  M.D.,  Stanly  County  Hospital,  Albemarle 

Eighth  District — Merle  D.  Bonner,  M.D.,  1023  N.  Elm  Street,  Greensboro 

Vice  Councilor — Harry  L.  Johnson,  M.D.,  P.O.  Box  530,  Elkin 
Ninth  District — Thomas  Lynch  Murphy,  M.D.,  116  Rutherford  St.,  Salisbury 

Vice  Councilor — Paul  McNeely  Deaton,  M.D.,  766   Hartness  St.,  Statesville 
Tenth  District — William  A.  Sams,  M.D.,  Main  Street,  Marshall 

Vice  Councilor — W.  Otis  Duck,  M.D.,  Drawer  517,  Mars  Hill 

DELEGATES  TO  THE  AMERICAN  MEDICAL  ASSOCIATION 

Elias  S.  Faison,  M.D.,  1012  Kings  Drive,  Charlotte 

C.  F.  Strosnider,  M.D.,  111  E.  Chestnut  Street,  Goldsboro 

Millard  D.  Hill,  M.D.,  15  W.  Hargett  Street,  Raleigh 

William  F.  Hollister,  M.D.,  (Alternate),  Pinehurst  Surgical  Clinic,  Pinehurst 

Joseph  F.  McGowan,  M.D.,   (Alternate),  29  Market  Street,  Asheville  p 

Wm.  McN.  Nicholson,  M.D.,   (Alternate),  Duke  Hospital,  Durham 

m 

SECTION  CHAIRMEN  1959-1960  cl 

General  Practice  of  Medicine — Julius  Sader,  M.D.,  205  East  Main  Street,  Brevard 
Internal  Medicine — Walter  Spaeth,   M.D.,  116   South  Road,  Elizabeth  City 
Ophthalmology  and  Otolaryngology — Charles  W.  Tillett,  Jr.,  M.D.,  1511   Scott 

Avenue,  Charlotte 
Surgery — JAMES  E.  DAVIS.  M.D.,  1200  Broad  Street,  Durham 
Pediatrics — William  W.  Farley,  M.D.,  903  West  Peace  Street,  Raleigh 
Obstetrics  &  Gynecology — H.  Fleming  Fuller,  M.D.,  Kinston  Clinic,  Kinston 
Public  Health  and  Education — ISA  C.  Grant,  M.D.,  Box  949,  Raleigh 
Neurology  &  Psychiatry — Myron  G.  Sandifer,  M.D.,  N.  C.   Memorial   Hospital, 

Chapel  Hill 
Radiology — Isadore  Meschan,  M.D.,  Bowman  Gray  School  of  Medicine, 

Winston-Salem 
Pathology — Roger  W.  Morrison,  M.D.,  65  Sunset  Parkway,  Asheville 
Anesthesia — Charles  E.  Whitcher,  M.D.,  Route  1,  Pfafftown 
Orthopedics  &   Traumatology — CHALMERS  R.   CARR,   M.D.,   1822   Brunswick    Avenue 

Charlotte 
Student  AMA  Chapters — Mr.  John  Feagin,  Duke  University  School  of  Medicine, 

Durham 


PAPAIN 

IS   THE 

KEY 

to  complete,  thorough 
vaginal  cleansing 


mucolytic,  acidifying, 
physiologic  vaginal  douche 


The  papain  content  of  Meta  Cine  is  the  key 
reason  why  it  effects  such  complete  cleansing  of 
the  vaginal  vault.  Papain  is  a  natural  digestant, 
and  is  capable  of  rendering  soluble  from  200- 
300  times  its  weight  of  coagulated  egg  albumin. 
In  the  vagina,  papain  serves  to  dissolve  mucus 
plugs  and  coagulum. 

Meta  Cine  also  contains  lactose — to  promote 
growth  of  desirable  Doderlein  bacilli — and 
methyl  salicylate,  eucalyptol,  menthol  and 
chlorothymol,  to  stimulate  both  circulation  and 
normal  protective  vaginal  secretions.  Meta 
Cine's  pleasant,  deodorizing,  non-medicinal  fra- 
grance will  meet  your  patients' esthetic  demands. 

Supplied  in  4  oz.  and  8  oz.  containers,  and  in 
boxes  of  30  individual-dose  packets.  Dosage: 
2  teaspoonfuls,  or  contents  of  1  packet,  in  2 
quarts  of  warm  water. 


lb 

HKAYTIN 


BRAYTEN    PHARMACEUTICAL  COMPANY  Chattanooga  9,  Tennessee 


When  summertime 
chores  bring  on 

LOW  BACK  PAIN 


Brand  of  chlormezanone 

relaxes  skeletal 

muscle  spasm - 

ends  disability. 


How  Supplied:  Trancopal  Caplets® 

200  mg.  (green  colored,  scored),  bottles  of  100. 
100  rag.  (peach  colored,  scored) ,  bottles  of  100. 

Dosage:  Adults,  200  or  100  mg.  orally  three  or  four 
times  daily.  Relief  of  symptoms  occurs  in  from 
fifteen  to  thirty  minutes  and  lasts  from  four  to  six 
hours. 

References:  1.  Lichtman,  A.  L.:  Kentucky  Acad.  Gen. 
Pract.  J.  4:28,  Oct.,  1958.  2.  Lichtman,  A.  L.:  Scientific 
Exhibit,  Internat.  Coll.  Surgeons,  Miami  Beach,  Fla.,  Jan. 
4-7,  1959.  3.  Gruenberg,  Friedrich:  Current  Therap.  Res. 
2:1,  Jan.,  1960.  4.  Kearney,  R.  D.:  Current  Therap.  Res. 
2:127,  April.  1960. 


LABORATORIES 
New  York  18,  N.Y. 


hen  any  of  a  host  of  summer  activities  brings  on  low  back  pain 
associated  with  skeletal  muscle  spasm,  your  patient  need  not  be  dis- 
abled or  even  uncomfortable.  The  spasm  can  be  relaxed  with 
Trancopal,  and  relief  of  pain  and  disability  will  follow  promptly. 

Lichtman1,2  used  Trancopal  to  treat  patients  with  low  back  pain, 
stiff  neck,  bursitis,  rheumatoid  arthritis,  osteoarthritis,  trauma,  and 
postoperative  muscle  spasm.  He  noted  that  Trancopal  produced 
satisfactory  relief  in  817  of  879  patients  (excellent  results  in  268, 
good  in  448  and  fair  in  101). 

Gruenberg3  prescribed  Trancopal  for  70  patients  with  low  back 
pain  and  observed  that  it  brought  marked  improvement  to  all.  "In 
addition  to  relieving  spasm  and  pain,  with  subsequent  improvement 
in  movement  and  function,  Trancopal  reduced  restlessness  and 
irritability  in  a  number  of  patients."3  In  another  series,  Kearney4 
reported  that  Trancopal  produced  relief  in  181  of  193  patients 
suffering  from  low  back  pain  and  other  forms  of  musculoskeletal 
spasm. 

Trancopal  enables  the  anxious  patient  to  work  or  play.  According 
to  Gruenberg,  "In  addition  to  relieving  muscle  spasm  in  a  variety 
of  musculoskeletal  and  neurologic  conditions,  Trancopal  also  exerts 
a  marked  tranquilizing  action  in  anxiety  and  tension  states."3 
Kearney4  found  ". . .  that  Trancopal  is  the  most  effective  oral  skeletal 
muscle  relaxant  and  mild  tranquilizer  currently  available." 

Side  effects  are  rare  and  mild.  "Trancopal  is  exceptionally  safe  for 
clinical  use."3  In  the  70  patients  with  low  back  pain  treated  by 
Gruenberg,3  the  only  side  effect  noted  was  mild  nausea  which  oc- 
curred in  2  patients.  In  Lichtman's  group,  "No  patient  discontinued 
chlormethazanone  [Trancopal]  because  of  intolerance."1 


July,  1960 


ADVERTISEMENTS 


XI 


ALL  OVER  AMERICA! 

KENTwiththe  MICRONITE  FILTER 

IS  SMOKED  BY 
MORE  SCIENTISTS  and  EDUCATORS 

than  any  other  cigarette!* 


FIVE  TOP  BRANDS 

OF 

CIGARETTES 

SMOKED  BY  AMERICAN 

SCIENTISTS 

15.3% 

10.5% 
7.9% 

BRAND  -F-  m— 1 

7.6% 

BRAND  "B    -"»■—'"■■' 

7.3% 

■■K 

FIVE  TOP  BRANDS  OF  CIGARETTES 
SMOKED  BY  AMERICAN  EDUCATORS 

BRAND  "G"  mil  ill Ml 

BRAND  "E" 
BRAND  ~A" 
BRAND  "F" 


THIS  does  not  constitute  a 
professional  endorsement 
of  Kent.  But  these  men,  like 
millions  of  other  Kent  smokers, 
smoke  for  pleasure,  and  choose 
their  cigarette  accordingly. 


The  rich  pleasure  of  smoking 
Kent  comes  from  the  flavor 
of  the  world's  finest  natural 
tobaccos,  and  the  free  and 
easy  draw  of  Kent's  famous 
Micronite  Filter. 


If  you  would  like  the  booklet,  "The  Story  of  Kent",  for  your 
own  use,  write  to:  P.  Lorillard  Company  — Research  De- 
partment, 200  East  42nd  Street,  New  York  17,  New  York. 


INO-1IZI, 
REOULAI    1UJ 
01  CRUIH-FIOOF  10ft 


For  good  smoking  taste,  WM  1S1¥ 

it  makes  good  sense  to  smoke  IBLIU  [Hill 


jf.  Results  ot  a  continuing  study  of  cigarette  preferences,  conducted  by  0'Bnen  Sherwood  Associates,  NT.,  NY. 
A  PRODUCT  OF  P  LORILLARD  COMPANY     FIRST  WITH  THE  FINEST  CIGARETTES    THROUGH  LORILLARD  RESEARCH 


O    ':.,'   ..^A'jia 


" 


life 
/saving 

in  /  many  cases . . 


-V 


NJECTION 


...a  highly  potent, 
bactericidal  antibiotic 
for  combating  staph  and 
gram  negative  infections 


Kanamycin  Sulfate  Injectton 


. .  .well  tolerated  when 
used  on  a  properly  individ- 
ualized dosage  schedule 
which  does  not  induce 
excessive  blood  levels 


"In  many  instances  its  effect  has  been  dramatic  and  life  saving . .  ."* 

"Six  of  the  patients  who  survived  were  considered  to  be  terminally  ill  at  the  time 
kanamycin  was  started  but  showed  dramatic  improvement  and  eventual  complete 
recovery 


»2 


". . .  indeed,  the  results  [with  kanamycin]  are  the  most  remarkable  ever  achieved 
with  otherwise  fatal  staphylococcal  infections  that  we  have  ever  seen."3 

"There  appears  to  be  no  doubt  that  kanamycin  has  been  lifesaving  in  those  in- 
stances in  which  organismal  resistance  precludes  the  use  of  other  antimicrobials."4 

Information  on  dosage,  administration  and  'precautions 
contained  in  package  insert  or  available  on  request. 

SUPPLY:  Kantrex  Injection,  0.5  Gm.  kanamycin  (as  sulfate)  in  vial  containing  2  ml.  volume. 
Kantrex  Injection,  1.0  Gm.  kanamycin  (as  sulfate)  in  vial  containing  3  ml.  volume. 

REFERENCES:   1.  Yow,  E.  M.:  Practitioner  182:759,  1959.  2.  Yow,  M.  D.,  and  Womack,  G.  K.:  Ann.  N.  Y.  Acad.  Sci.  76:363, 
1958.  3.  Bunn,  P.  A.,  Baltch,  A.,  and  Krajnyak,  0.:  Ibid.  76:109,  1958.   4.  Council  on  Drugs,  J.A.M.A.  172:699,  1960. 


BRISTOL  LABORATORIES,  SYRACUSE,  NEW  YORK 


7 


Vhen  STRESS  accompanies  secondary  anemias 


IBIlIWi 

gtjgfc 

us   Fumarate 

ISO  mg 

180  mg.  Fe 

in  B-12  with  Intrinsic  Fictor 
ntrate,  Non-Inhibitory 

1/9  USF 
Oral  Uni 

1/3  USP 
t               Oral  Unit 
(6  meg.  B-12) 

4  meg  B-12 

bic  Acid 

100  mg 

300  mg. 

300    mg. 

Tine  Mononitrate    (B-l) 

3  3      mn 

10  mg. 

10  mg. 

avin   (B-2> 

T    '■       mg 

10  mg. 

10  mg. 

oxine  Hydrochloride   (B-6) 

0.67  mg 

2  0      mg. 

2.0  mg. 

namide 

33.3     mg 

100  mg. 

100  mg. 

jm   Pantohenate 

6.67  mg 

20  mg. 

20  mg. 

Acid 

0.5     mg 

1.5     mg. 

1.5  mg. 

w   (From  Copper  Sulfate) 

3.0     mg 

9.0     mg. 

anese  (From  Mn  Sulfate) 

3.0     mg 

9.0     mgr. 

t   (From   Cobalt  Sulfate! 

0.05  mg 

0.15  mg. 

(From  Zinc  Sulfate) 

0.3     mg 

0.9     mg. 

This  unique  comprehensive  formula  provides  a  broad  new  concept  in  the  treatment 
of  anemias,  in  convalescence,  and  in  the  prevention  and  treatment  of  nutritioi 
deficiencies.  As  indicated  by  its  formula,  dosage  control  is  more  easily  maintains 
with  HEMOTREXIN.  All  treatable  secondary' anemias,  especially  when  aceonv 
panied  by  stress  conditions,  as  in  anemias  of  pregnancy,  convalescence,  adolescence 
post-infection  anemias,  anemias  following  drug  therapy,  and  in  the  prevention  am 
treatment  of  nutritional  deficiencies  .  .  .  respond  favorably  to  HEMOTREXIN. 


DOSAGE 

Adults:  one    tablet    three    times   daily  after 

meals. 
Children:  one  to  three  tablets  according  to 
age. 


"r?nrpr7JT7r7orPT7  nr?/^7 


SAMPLES  AND 
LITERATURE 
GLADLY  SENT 
UPON  REQUEST. 


Raise  the  Pain  Threshold 


Phenaphen  with  Codeine  provides 

intensified  codeine  effects  with 

control  of  adverse  reactions. 

It  renders  unnecessary  (or  postpones) 

the  use  of  morphine  or  addicting 

synthetic  narcotics,  even  in 

many  cases  of  late  cancer.. 


Three  Strengths  — 

PHENAPHEN  NO.  2 

Phenaphen  with  Codeine  Phosphate  Vt  gr.  (16.2  mg.) 

PHENAPHEN  NO.  3 

Phenaphen  with  Codeine  Phosphate  Vi  gr.  (32.4  mg.) 

PHENAPHEN  NO.  4 

Phenaphen  with  Codeine  Phosphate  1  gr.  (64.8  mg.) 

Aho- 

PHENAPHEN       In  each  cap.ule 

Acetylsalicylic  Acid  2%  gr.  .      (162  mg.) 

Phenacetin  3  gr (194  mg.) 

Phenobarbital  %  gr. (16.2  mg.) 

Hyoscyamine  sulfate (0.031  mg.) 


PHENAPHEN  with  CODEINEh 


Rgbins    | 


A.  H.  ROBINS   CO..  INC.,  RICHMOND   20.  VIRGINIA 
Ethical  Pharmaceuticals  of  Merit  since  1878 


•  • 


—  % 


}■ 


s*~e 


-A  »  •.  •.  ;.    • -:::*■■*  r    \'h  \    •■:-'..•  /*s*V 

*  • **" ••..•;::  •-•.'M'i '•".:.  .••'       •.•-•-„••••'       "••.*«.«     •*.      • 

.•,      ■•:'•!...  ...„..:*.•;..-.••- •'.-?..:*   :    ...    ■„■>.■  ',-.  .;.  '  :  •  *■>-  •     ••    •.  . 

:•.••■•*•  '.   .:•      *     .•:."/... ■•'.'  •'••:  •••'••'     ••    V     *'  .'.••'5/-.r;.:-  ."•    *- ;  • 

■•..•/.•.". •'.•..;•.      '.*•  ■'■:■'• :••'•■  \V     . ^.Vi- »V. ;       .  ,    /  A-S  .•''•''£".•  .*,.'  - 

•  ••'.•*   .•*.        .•  V'i'v  :'•;'.•'■  •'.'••'.:•;*•  .'   ^\".1'°- •.•.'.'•"/"/.•—•I-     <".'•..■•  ..7-  '    •'•*/ *.     •    ■**• 

■•'.  ...••:■•.'•        •••■v.-.:..-." -'•'•  -v-v*  •*.-  •'••    •'   -.•''•••••:•     •  ■    •-.-.   "•    .'-.♦• 
:•••       .•••;v//-.Vv-'sV-.". '•.;;»  v •*..    ...•••/•:;;•••.    ••     "•>:-:.•;.-' 

■-.'••"i: ::■/.'• '.••••'    r-'.." './•>'•  ;'..•;•:  .•*/•.-.•/  ::  •.  •:  -v.    -.*•  ■;•/.'  -.•..•/  ' 
."■•''    .  •'.-■   •  ■  .•*  '■•  .'•.'''..•'"'■••        '.•■■•   '    *♦.»•'    . 

Triaminic 

...relief  from  pollen  allergies 

more  complete  than  antihistamines  alone... more  thorough  than  nose  drops  or  sprays 

The  miseries  of  respiratory  allergy  can  be  relieved  so  effectively 
with  Triaminic.15  Triaminic  contains  two  antihistamines  plus 
the  decongestant,  phenylpropanolamine,  to  help  shrink  the  en- 
gorged capillaries,  reduce  congestion  and  bring  relief  from  rhin- 
orrhea  and  sinusitis.1  Oral  administration  distributes  medication 
to  all  respiratory  membranes  without  risk  of  "nose  drop  addic- 
tion" or  rebound  congestion.-3 

Each  Triaminic  timed-release  Tablet  provides: 

Phenylpropanolamine  HCI    50  mg. 

Pheniramine  maleate    25  mg. 

Pyrilamine  maleate 25  mg. 

also  available: 

TRIAMINIC  JUVELETSS  Vi  the  formulation  of  the  Triaminic  Tablet  with  timed-release  action. 

TRIAMINIC  SYRUP  each  teaspoonful  (5  ml.)  provides  Va  the  formulation  of  the  Triaminic  Tablet. 

References:  1.  Fabrlcant,  N.  D.:  E.  E.  N.T.  Monthly  37:460  (July)  1958.  2.  Lhotka.  F.  M.:  Illinois  M.J.  112  259 
(Dec  )  1957.  3.  Farmer,  D.  F.:  Clin.  Med.  5:1183  (Sept.)  1958.  4.  Fuchs,  M.;  Bodi.T.:  Mallen,  S.  R.;  Hernando.  L, 
and  Moyer,  J.H.:  Antibiotic  Med.  &.  Clin.  Ther.  7:37  (Jan)  1960.  5.  Halpern,  S.  R..  and  Rabinowitz,  H.:  Ann. 
Allergy  18:36  (Jan.)  1960. 

«4jfl  ^^       .  first— the  outer  layer  dissolves 
jr^i  "^^^^  within  minutes  to  produce 

Relief  Is  prompt  and  prolonged    jj  \^^^\  J        3  to  4  hours  of  relief 

because  of  this  special  BP  JL  /"       x 

Pl^fc^^j^^  ^  then  — the  core  disintegrates 

timed-release  action  \§j/p      ^^T~^™Bt0  give  3 10  4  mcre 


S??????0      8 


*  *  S  i  8  *  * 


*  ?   2   S    ? 


'  s 
i 
s 


GONORRHEA  IS  ON  THE  MARCH  AGAIN... 


a  new  timetable  for  recovery: 

only  six  capsules  of  TETREX  can  cure  a  male  patient  with  gonorrhea  in  just  one  day4 


Tet 


® 


U.S.  PAT.  NO. 2. 791,609 

THE   ORIGINAL   TETRACYCLINE    PHOSPHATE   COMPLEX 


TETREX   CAPSULES.  250   mg.   Each   capsule   contains: 
TETREX  (tetracycline  phosphate  complex  equivalent  to 
tetracycline  HCI  activity)  -  250  mg. 
DOSAGE:   Gonorrhea  in  the  male -Six  capsules  of 
TETREX  in  3  divided  doses,  in  one  day. 

v  Marmell,  M.,  and  Prigot,  A.:  Tetracycline  phosphate  complex  in  the  treat- 
ment of  acute  qonococcal  urethritis  in  men.  Antibiotic  Med.  &  Clin.  Ther. 
6:108  (Feb)  1959. 


BRISTOL  LABORATORIES, 

SYRACUSE,  NEW  YORK 


THE 

REALMS 

OF  THERAPY 


|    fBASSPDRT 
TO,    - 
TRANQUILH*Y 


ATTAINED 
WITH 


ATA  RAX 


(brand  of  hydroxyzine) 


V  World-wide  record  of  effectiveness-over  200  labora- 
tory and  clinical  papers  from  14  countries. 
Widest  latitude  of  safety  and  flexibility-no  serious 
adverse  clinical  reaction  ever  documented. 
Chemically  distinct  among  tranquilizers— not  a  pheno- 
thiazine  or  a  meprobamate. 
Added  frontiers  of  usefulness— antihistamine;  mildly 
antiarrhythmic;  does  not  stimulate  gastric  secretion. 


Special  Advantages 


unusually  safe;  tasty  syrup, 
10  mg.  tablet 


well  tolerated  by  debilitated 
patients 


useful  adjunctive  therapy  for 
asthma  and  dermatosis;  par- 
ticularly effective  in  urticaria 


W         IN 

i  HYPEREMOTIVE  § 

does  not  impair  mental  acuity 


Supportive  Clinical  Observation 

". . .  Atarax  appeared  to  reduce  anxiety 
and  restlessness,  improve  sleep  pat- 
terns and  make  the  child  more  amen- 
able to  the  development  of  new  pat- 
terns of  behavior. . . ."  Freedman,  A. 
M.:  Pediat.  Clin.  North  America  5:573 
(Aug.)  1958. 


". . .  seems  to  be  the  agent  of  choice 
in  patients  suffering  from  removal  dis- 
orientation, confusion,  conversion  hys- 
teria and  other  psychoneurotic  condi- 
tions occurring  in  old  age."  Smigel, 
J.  0.,  et  al.:  J.  Am.  Geriatrics  Soc. 
7:61  (Jan.)  1959. 


"All  [asthmatic]  patients  reported 
greater  calmness  and  were  able  to 
rest  and  sleep  better... and  led  a 
more  normal  life. ...  In  chronic  and 
acute  urticaria,  however,  hydroxyzine 
was  effective  as  the  sole  medica- 
ment." Santos,  I.  M.,  and  Unger,  L: 
Presented  at  14th  Annual  Congress, 
American  College  of  Allergists,  Atlan- 
tic City,  New  Jersey,  April  23-25, 1958. 


L 


". . .  especially  well-suited  for  ambula- 
tory neurotics  who  must  work,  drive 
a  car,  or  operate  machinery."  Ayd,  F. 
J.,  Jr.:  New  York  J.  Med.  57:1742  (May 
15)  1957. 


New  York  17,  N.Y. 

Division,  Chas.  Pfizer  &  Co.,  Inc. 

Science  for  the  World's  Weil-Being 


.and  for  additional  evidence 


Bayart,  J.:  Acta  paediat.  belg. 
10:164,  1956.  Ayd,  F.  J.,  Jr.:  Cal- 
ifornia Med.  87:75  (Aug.)  1957. 
Nathan,  L.  A.,  and  Andelman,  M. 
B.:  Illinois  M.  J.  112:171  (Oct.) 
1957. 


Settel,  E.:  Am.  Pract.  &  Digest 
Treat.  8:1584  (Oct.)  1957.  Negri, 
F.:  Minerva  med.  48:607  (Feb. 
21)  1957.  Shalowitz,  M.:  Geri- 
atrics 11:312  (July)  1956. 


Eisenberg,  B.  C:  J.A.M.A.  169:14 
(Jan.  3)  1959.  Coirault,  R„  et  al.: 
Presse  mki.  64:2239  (Dec.  26) 
1956.  Robinson,  H.  M..  Jr.,  et  al.: 
South.  M.  J.  50:1282  (Oct.)  1957. 


^^ 


Garber,  R.  C,  Jr.:  J.  Florida  M. 
A.  45:549  (Nov.)  1958.  Menger, 
H.  C.i  New  York  J.  Med.  58:1684' 
(May  15)  1958.  Farah,  L:  Inter- 
nat.  Rec.  Med.  169:379  (June) 
1956. 

SUPPLIED:  Tablets,  10  mg.,  25 
mg.,  100  mg.;  bottles  of  100. 
Syrup  (10  mg.  per  tsp.),  pint 
bottles.  Parenteral  Solution:  25 
mg./cc.  in  10  cc.  multiple-dose 
vials;  50  mg./cc.  in  2  cc.  am- 
pules. 


J 


IN  ORAL  CONTROL  OF  PAIN 


ACTS  FASTER-usua I ly  within  5-15  minutes.  LASTS  LONGER-usually 
6  hours  or  more.  MORE  THOROUGH  RELIEF- permits  uninterrupted 
sleep  through  the  night.  RARELY  CONSTIPATES-excellent  for 
chronic  or  bedridden  patients. 

average  adult  dose:  1  tablet  every  6  hours.  May  be  habit-forming.  Federal  law 
permits  oral  prescription. 

Each  Percodan*  Tablet  contains  4.50  mg.  dihydrohydroxycodeinone  hydro- 
chloride, 0.38  mg.  dihydrohydroxycodeinone  terephthalate,  0.38  mg.  homa- 
tropine  terephthalate,  224  mg:  acetylsalicylic  acid,  160  mg.  phenacetin,  and 
32  mg.  caffeine. 

Also  available  —  for  greater  flexibility  in  dosage  -  Percodan®-Demi:  The 
Percodan  formula  with  one-half  the  amount  of  salts  of  dihydrohydroxyco- 
deinone and  homatropine. 

Literature?  Write 

ENDO   LABORATORIES 

Richmond  Hill  18,  New  York 


$«S 


Percodan 

Salts  of  Dihydrohydroxycodeinone  and  Homatropine,  plus  APC 


Tablets 


FOR  PAIN 


•U.S.  Pat.  2,628,185 


July,  1960 


ADVERTISEMENTS 


XXI 


I 


ECLOMYCIN  NOTES: 


Demethylchiortetracycllne  Ledefle 


pathogen 

sensitivity 


In  addition  to  the  expected  broad- 
spectrum  range  of  effectiveness, 
Declomycin  has  demonstrated  ac- 
tivity against  strains  of  Pseudomo- 
nas,  Proteus  and  A.  aerogenes    un- 


responsive 

refractory 

antibiotics. 


1.  Finland,  M.;  Hlrsch,  H.  A.,  and  Kunin,  C. 
M.:  Read  at  Seventh  Annual  Antibiotics  Sym- 
posium, Washington,  D.  C,  November  5, 
1959.  2.  Hirsch,  H.  A.;  Kunin,  C.  M.,  and 
Finland,  M.:  Miinchen.  med.  Wchnschr.  To  be 
published.  3.  Roberts,  M.  S.;  Seneca,  H.,  and 
Lattimer,  J.  K.:  Read  at  Seventh  Annual 
Antibiotics  Symposium,  Washington,  D.  C, 
November  5,  1959.  4.  Vineyard,  J.  P.;  Hogan, 
J.,  and  Sanford,  J.  P.:  Ibid. 

Capsules,    150    mg.  —  Pediatric    Drops,   60 
mg./cc.  —  New    Syrup,    cherry-flavored,    75     / 
mg./5  cc.  tsp.,  in  2  fl.  oz.  bottle  —  3-6  mg. 
per  lb.  daily  in  four  divided  doses. 


A. 
aerogenes 


or  highly 


Xto  other 

reeudomonas)' 


GREATER   ACTIVITY...  FAR    LESS   ANTIBIOTIC  ...  SUSTAINED-PEAK   CONTROL ...  "EXTRA-DAY"    PROTECTION    AGAINST    RELAPSE 

LEDERLE  LABORATORIES,  a  Division  of  AMERICAN   CYANAMID   COMPANY,  Pearl   River,  New  York 


XXII 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July,  I960 


For  topical  infections, 

choose  a 'B.  W.  &  Co." 'SPORIN'. . . 


.— / 


CORTISPORIN 


brand  OINTMENT 


Combines  the  anti- 
inflammatory effect 
of  hydrocortisone  with 
the  comprehensive 
bactericidal  action 
of  the  antibiotics. 


Each  gram  contains:  Neomycin  Sulfate 5  mg. 

'Aerosporin'®  brand  Polymyxin  B  Sulfate  5,000  Units       Hydrocortisone     (1%)   10  mS- 

Zinc  Bacitracin 400  Units      in  a  special  petrolatum  base. 


Each  gram  contains: 

'Aerosporin'®  brand  Polymyxin  B  Sulfate  5,000  Units      Zinc  Bacitracin 

Neomycin  Sulfate 5  mg.         in  a  special  petrolatum  base. 


400  Units 


V.. 


POLYSPORIN' 

brand  ANTIBIOTIC  OINTMENT 


Offers  combined  anti- 
biotic action  for  treating 
conditions  due  to  suscep- 
tible organisms  amenable 
to  local  medication. 


u 


Each  gram  contains: 

'Aerosporin'®  brand  Zinc  Bacitracin    500  Units 

Polymyxin  B  Sulfate 10,000  Units       in  a  special  petrolatum  base. 


BURROUGHS  WELLCOME  &  CO.  (U.S.A.)  INC.,  Tuckahoe,  N.  Y. 


•  ••••• 


isual  medications 
act  only  here 


u  w| 


p»  •  • 


elief  in  HAY  FEVER 


*%    . 


« 


.**) 


■ 


3«« 


NEW 


\ 


•  • 


acts  here 


to  relieve  both  nasal 


and  chest  discomfort 


»» •••« 


', 


BHL- 


I  m  L»  V  v 


/upper  respiratory  decongestion 
and  bronchial  decongestion 

Many  hay  fever  patients  also  experience  chest  discomfort.  For  these  patients, 

new  ISOCLOR  provides  relief  along  the  entire  respiratory  tract. 

COMBINES  the  nasal  and  bronchial  decongestant  action  of  d-isoephedrine  with 

the  histamine  blocking  action  of  chlorpheniramine. 

RELIEVES  the  discomforts  of  rhinorrhea,  itching,  sneezing,  hyperlacrimation 

and  post  nasal  drip— let  s  the  patient  get  a  full  night's  rest— with  minimal  daytime 

drowsiness,  CNS  or  pressor  stimulation. 

TABLETS  AND  SYRUP  for  adults  and  children  . . . 
COMPOSITION:  Per  tablet        Per  5  ml.  syrup 

Chlorpheniramine  maleate 4  mg.  2  mg.  -    _    .  .    .    —       P  T  n  II  T 

d-lsoephedrine  HCI 25  mg.  12.5  mg.  AKNAK'olUNt 

DOSE:  Tablets:  One  tablet  3  or  4  times  daily.  Syrup:  Children:  3-6  yrs.  Laboratories       InC 

'/;  tsp.  t.i.d.;  6-12  yrs.  1  tsp.  t.i.d.;  Adults:  2  tsp.  t.i.d. 

AVAILABLE:  Tablets:  Bottles  of  100.  Syrup:  Pint  bottles.  Mt.     Prospect,     Illinois 


\j*t-fifjfl 

V': 

fi|nH           '^iM 

K    ■ 

1       ^K   ■ 

1       '■             lifaff    ^A 

3Ht.3B», 


ffiH^ 


^V*tr~'. 


'8[*  ■    - 


!« 


"Tfo  amc^tf  of  treating  hypertension  with  a  potent  oral  diuretic  in  combination 
with  one  or  more  of  the  sympathetic  depressant  drugs  is  a  new  one." 

Salutensin  samples  available  on  request 


Gentlemfn:  Please  send  me  a  complimentary  supply  of 
Salutf.nsin  Tablets. 


Dr.. 


Street_ 
City 


_ZONE_ 


_State_ 


Signature. 


Send   coupon    to:   Bristol  Laboratories,   Syracuse,   New   York. 


REFERENCES:  1.  Gifford,  R. 
W.,  Jr.,  In  Hypertension,  ed.  by 
J.  H.  Moyer,  Saunders,  Philadel- 
phia, 1959,  p.  561.  2.  Moyer, 
J.  H.:  Ibid.  p.  299.  3.  Brodie, 
B.  B.:  In  Hypertension,  Vol.  VII, 
Proceedings  Council  for  High 
Blood  Pressure  Research,  Am. 
Heart  Assn.,  ed.  by  F.  R.  Skelton, 
1959,  p.  82.  4.  Wilkins,  R.  W.: 
Ann.  Int.  Med.  50:1,  1959.  5. 
Freis,  E.  D.:  In  Hypertension,  ed. 
by  Moyer,  op.  cit.,  p.  123.  6. 
Ford,  R.  V.,  and  Nickell,  J.:  Ant. 
Med.  »  Clin.  Ther.  6:461,  1959. 
7.  Fuchs,  M.,  and  Mallin,  S.  R.: 
Int.  Red.  Med.   172:438,  1959. 


NEW 


For  the  "multi-system  disease"2  HYPERTENSION, 
an  integrated  multi-therapeutic  antihypertensive... 


A  multi-system  disease  such  as  essential  hypertension  often  requires  a  multi-therapeutic  approach  (or  satisfactory 
control.  Salutensin  combines  in  balanced  proportions  three  clinically  proven  antihypertensives.  These  components 
act  through  three  different  physiologic  mechanisms  to  offer  greater  therapeutic  benefits  while  minimizing  the  risk  of 
side  effects  sometimes  observed  in  patients  on  single  drug  therapy  at  maximally  effective  doses.  The  components  in 
each  Salutensin  Tablet: 

Saluron  (hydroflumethiazide  Bristol)  —  a  saluretic-antihypertensive  agent  postulated  to  lower  elevated  blood  pres- 
sure by  affecting  vascular  reactivity  to  a  still  unknown  pressor  mechanism 50  mg. 

Reserpine  —  a  tranquilizing  drug  with  peripheral  vasorelaxant  effects,  which  have  been  described  as  a  "chemical 

sympathectomy"3 0.125  mg. 

Protoveratrine  A—"&  potent  hypotensive  drug"4  which  is  "well  tolerated"  in  combination  with  rauwolfia;4  a  cen- 
trally mediated  vasorelaxant  that  produces  "the  most  physiologic,  hemodynamic  reversal  of  hypertension"5.. ..0.2  mg. 

Indications:  Essential  hypertension;  hypertensive  cardiovascular  disease;  insufficient  response  to  a  single  or  dual 
antihypertensive  agent;  partial  or  complete  replacement  of  potentially  more  toxic  agents. 

Salutensin  should  be  used  cautiously  in  hypertensive  patients  with  renal  insufficiency,  particularly  if  such  patients 
are  digitalized. 

Dosage:  Usual  adult  dose  1  tablet  twice  daily.  Detailed  information  on  dosage  and  precautions  in  official  package 
circular  or  available  on  request. 

ply:  Bottles  of  60  scored  tablets. 


A  sustained-action  foundation  drug  for  an  antihypertensive  regimen 

saLuroN 


sustained-action  hydroflumethiazide  'Bristol' 

Saluron  is  an  economical,  well-tolerated  salutensive  agent  —  saluretic  and  antihypertensive  —  for 
foundation  drug  in  the  treatment  of  hypertension.  In  mild  to  moderate  hypertension,  Saluron 
adequate  by  itself.  It  has  been  described  as  "a  distinct  advantage  in  the  manifestations  of  hypert 
and  "a  marked  advancement  in  the  field  of  diuretic  therapy."7 

Dosage:  Usually  1  tablet  daily.  Full  information  in  official  package  circular. 

SurrLY:  Scored  50-mg.  tablets,  bottles  of  50. 

BRISTOL  LABORATORIES,  Syracuse,  New  York 


use  as  a 
often  is 
ension"6 


XXVI  NORTH  CAROLINA  MEDICAL  JOURNAL  July,  1960 


FOR 

SULFONAMIDE 
THERAPY 


NEW 


DR4P 
DOSAGE 
F*RM 
CHERRY 
FLAVORED 


N     Acetyl  Sulfamethoxypyridazine 

PEDIATRIC   DROPS 

I  I  single,  daily-dose  effectiveness  □  rapid, 
sustained  action  against  sulfa-susceptible 
organisms  □  125  mg.  sulfamethoxypyrida- 
zine  activity  per  cc.  in  10  cc.  squeeze  bottle 

Dosage:   First  day,  2  cc.  (250  mg.)  for  each   20  lbs.    body  weight;  thereafter,  1   cc. 
(125  mg.)  for  each   20  lbs-  Should   be  given  once  a  day  immediately  after  a   meal. 

LEDERLE  LABORATORIES,  a  Division  of  AMERICAN  CYANAMID  COMPANY,  Pearl  River,  New  York 


■  .• 


Of  course,  women  like  "Premarin" 


rpHERAPY  for  the  menopause  syn- 
■*■  drome  should  relieve  not  only  the 
psychic  instability  attendant  the  con- 
dition, but  the  vasomotor  instability 
ot  estrogen  decline  as  well.  Though 
they  would  have  a  hard  time  explain- 
ing it  in  such  medical  terms,  this  is 
the  reason  women  like  "Premarin." 
The  patient  isn't  alone  in  her  de- 


votion to  this  natural  estrogen.  Doc- 
tors, husbands,  and  family  all  like 
what  it  does  for  the  patient,  the  wife, 
and  the  homemaker. 

When,  because  of  the  menopause, 
the  psyche  needs  nursing— "Premarin" 
nurses.  When  hot  flushes  need  sup- 
pressing, "Premarin"  suppresses.  In 
short,  when  you  want  to  treat  the 


whole  menopause,  (and  how  else  is 
it  to  be  treated?),  let  your  choice  be 
"Premarin,"  a  complete  natural  es- 
trogen complex. 

"Premarin,"  conjugated  estrogens 
(equine),  is  available  as  tablets  and 
liquid,  and  also  in  combination  with 
meprobamate  or  methyltestosterone. 
Ayerst  Laboratories*  New  York  /~~~\  3 
16,  N.  Y.  •  Montreal,  Canada  \^»0  " 


^AL  potassium  phenethicillin 


YNCI 


J 


LIN 

(Potassium  Penicilliu-152) 


higher  peak  blood  levels 

than  with  potassium  penicillin  V 

higher  initial  peak  blood  levels 
than  with  intramuscular  penicillin  G 


increased  dosage  increases 
serum  levels  proportionally 


superior  to  other  penicillins 
in  killing  many  staph  strains 


A  dosage  form  to  meet  the  individual 
requirements  of  patients  of  all  ages 
in  home,  office,  clinic  and  hospital: 

Syncillin  Tablets-250  nig. . . .  Syncillin  Tablets-125  mg. 

Syncillin  for  Oral  Solution  — 60  nil.  bottles— when  reconstituted, 
125  nig.  per  5  ml. 

Syncillin  Pediatric  Drops  —  1.5  Gni.  bottles.  Calibrated  dropper 
delivers  125  nig. 

Complete  information  on  indications,  dosage  and  precautions  is 
included  in  the  official  circular  accompanying  each  package. 


clears  ringworm  orally   regardless  of  duration 
or  previous  resistance  to  treatment 

spares  the  patient—  embarrassment  of  epilation  and 
skullcaps,  difficulty  and  ineffectiveness  of  topical 
medications,   potential   hazard  of  x-ray  treatments 


XXX 


NORTH  CAROLINA  MEDICAL  JOURNAL 


July,   I960 


Co-Pyronir 

keeps  most  allergic  patients 
symptom-free  around  the  clock 


Many  allergic  patients  require  only  one  Pulvule®  Co-Pyronil 
every  twelve*  hours,  because  Co-Pyronil  provides: 

•  Prolonged  antihistaminic  action 

•  Fast  antihistaminic  action 

plus 

•  Safe,  effective  sympathomimetic  therapy 

*Unusually  severe  allergic  conditions  may  require  more  fre- 
quent administration.  Co-Pyronil  rarely  causes  sedation  and, 
even  in  high  dosage,  has  a  very  low  incidence  of  side-effects. 

Supplied  as  Pulvules,  Suspension,  and 
Pediatric  Pulvules. 

Co-Pyronil"  (pyrrobutamine  compound,  Lilly) 


ELI      LILLY      AND      COMPANY      •      INDIANAPOLIS      6,      INDIANA,      U.S.A. 

658012 


North  Carolina  Medical  Journal 

Owned  and  Published  by 
The  Medical  Society  of  the  State  of  North  Carolina 


Volume  21 


July,  1960 


No.  7 


Presidents  Inaugural  Address 


Amos  N.  Johnson,  M.D. 
Garland 


I  am  grateful  to  you  for  having  elected 
me  to  be  your  president.  I  repeat  the  words 
of  Dr.  Paul  McCain  on  the  occasion  of  his 
inauguration:  "To  have  been  selected  and 
elected  to  leadership  by  those  people  who 
know  you  best,  your  fellow  physicians,  is 
the  highest  honor  that  can  come  to  anyone" ; 
and  I  am  grateful  for  it.  As  I  now  assume 
this  responsibility  and  honor,  I  am  mindful 
of  many  things. 

I  am  mindful  of  the  constant  and  contin- 
uous change  that  is  going  on  in  this  world 
and  of  the  rapidity  with  which  events  move 
|  from  day  to  day. 

I  am  also  mindful  that  there  is  a  cancer 
eating  at  Medicine  continuously — a  social, 
a  political,  and  an  economic  cancer  that 
we  must  watch  and  attempt  to  eradicate. 
It  is  invading  the  profession  from  the 
periphery,  from  the  heart,  from  the  inside, 
from  within  Medicine  itself. 

I  am  mindful  that  when  one  person  or 
one  group  loses  its  freedom,  the  freedom  of 
all  people  is  weakened;  that  abject  and  un- 
reasoning conformity  is  the  first  symptom 
of  mediocrity  and  eventual  decay.  Someone 
said  that  he  who  dares  stick  his  head  above 
the  flowing  tide  of  mediocrity  is  sure  to 
have  something  thrown  at  him,  but  I  say  to 
you  that  it  is  only  by  continued,  tireless  ef- 
fort to  rise  above  the  commonplace  and  to 
produce  something  of  excellence  that  one 
attains  success.  Therefore  I  pledge  to  you 
that  this  year  I  will  make  every  effort,  with 
your  help  and  the  help  of  our  capable  staff 
in  Raleigh,  to  keep  the  head  of  Medicine 
above  the  level  of  mediocrity,  even  though 
I  may  be  fired  upon.  And,  in  the  sniping  at 
me,  medicine  may  be  jarred  a  bit,  but  we 
will  engage  our  enemy  and  find  his  position 
and  strength  wherever   he   is   recognized. 


Read    before    the    Second    General    Session,    Medical    Society    of 
the   State   of   North   Carolina.    Raleigh,    May    11.    1960. 


Legislative  Issues 
I  must  mention  some  of  the  issues  which 
we  will  have  to  face  this  year.  You  have 
heard  the  discussions  relative  to  legislation 
affecting  medicine.  In  this  day  of  govern- 
ment coddling  minority  groups,  medicine  is 
the  whipping  boy.  Why?  Because  the  poli- 
ticians who  run  our  country  think  that 
more  votes  can  be  gained  by  maligning  us 
and  making  us  the  villains  than  by  shower- 
ing us  with  favors.  So  we  are  a  unique  min- 
ority who  must  be  constantly  alert  to  tell 
our  story  to  all  with  whom  we  come  in  con- 
tact. Today's  trend  in  Washington,  as  de- 
picted on  television,  radio  and  the  press,  is 
for  Government  to  be  all  things  to  all  peo- 
ple, to  give  everything  to  everybody.  That 
is  why  we  must  be  diligent  in  making  our 
cause  known.  We  must  educate  and  in- 
fluence our  politicians  before  they  give 
away  the  privileges  and  financial  security 
of  all  the  people  in  this  country. 

Integration  of  Negro  Physicians 
Concerning  the  integration  of  Negro 
physicians  into  the  Medical  Society  of  the 
State  of  North  Carolina,  I  have  secured  the 
original  copy  of  the  report  filed  by  the  com- 
mittee appointed  by  President  Zack  Owens 
to  study  this  problem.  In  brief,  the  report 
states  that  a  thorough  study  and  meeting 
of  minds  between  this  committee  and  em- 
powered representatives  of  the  Old  North 
State  Medical  Society  resulted  in  the  con- 
clusion that  there  was  a  difference  in  the 
social  structure  of  the  races  which  pre- 
cluded integration  at  a  social  level,  but 
that  there  was  a  need  and  a  desire  to  make 
the  scientific  facilities  of  this  Society  avail- 
able to  physicians  of  the  Negro  race.  A 
statement  of  agreement  was  then  reached :  a 
statement  which  gave  these  colored  phy- 
sicians every  thing  they  asked  and  every 
thing  they  implied  they  needed.  They  were 
given  access  to  the  American  Medical   As- 


262 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July,   1960 


sociation  and  national  specialty  boards 
through  scientific  membership  in  our  State 
Society;  access  to  the  North  Carolina  ex- 
amining and  licensing  board  by  the  priv- 
ilege of  nominating  candidates  and  voting 
in  these  elections. 

After  all  this,  we  have  two  scientific 
members.  Every  Negro  doctor  in  North 
Carolina  could  belong  to  our  Society  and 
could  be  sitting  there  with  you  today ;  how- 
ever, of  this  privilege  only  two  have  availed 
themselves,  and  neither  of  them  have  I 
ever  seen  at  a  scientific  session.  After  the 
original  agreement  was  reached,  their  atti- 
tude quickly  changed,  probably  touched  by 
an  outside  influence  persuasive  enough  to 
make  them  decide  that  they  didn't  get  what 
they  really  wanted  the  first  time.  Now, 
after  a  short  four  or  five  years,  they  come 
back  and  want  full  membership. 

I  say  to  you  that  it  is  not  we,  the  mem- 
bers of  the  Medical  Society  of  the  State  of 
North  Carolina,  who  will  bear  the  onus  of 
what  will  happen  as  a  result  of  the  un- 
pleasantness that  is  sure  to  come.  We  have 
not  broken  the  faith ;  they,  the  members  of 
the  Old  North  State  Medical  Society,  have 
broken  the  faith  under  the  pressure  and 
duress  of  the  NAACP,  whose  sole  purpose 
is  to  foment  trouble,  unrest  and  disorder. 

That  brings  us  up  to  the  point  at  hand. 
You  take  my  word  that  what  I  have  told  you 
is  true,  that  we  went  the  full  distance,  the 
last  mile.  They  want  to  dance  with  us,  they 
want  to  sit  at  our  banquet  tables,  they 
want  to  associate  with  us  socially.  Now, 
maybe  it  is  all  right  for  them  to  want  that. 
I  cannot  judge,  since  I  cannot  put  myself 
in  their  position.  My  perspective  must 
necessarily  be  purely  objective.  But  when 
I  go  back  and  think  of  what  is  basically 
right  and  on  what  grounds  they  have  to  de- 
mand this,  I  think  of  other  creatures  of  na- 
ture. The  tiger  doesn't  consort  with  the 
lion  when  sundown  comes.  Each  goes  to 
his  own  den.  The  fox  doesn't  knock  on  the 
kennel  door  to  lie  down  with  the  hound, 
though  they  are  closely  related.  The  duck 
and  swan  do  not  fly  North  together.  I  do 
not  know  that  there  is  any  sociologic  or  bio- 
logic law  that  says  we  must  integrate  two 
elements  of  our  society  that  are  presently 
as  separate  and  diverse  as  are  these  two 
races. 


We  now  have  the  problem  of  what  to  do. 
First,  I  propose  to  reactivate  and  enlarge 
the  committee  appointed  by  Dr.  Owens.  I 
propose  to  strengthen  it,  to  confer  with  it 
and  ask  it  then  to  study  and  recommend 
what  we  can  do  as  a  Society  to  meet  this 
situation.  It  occurs  to  me  that  we  can  do 
two  things :  We  can  stand  our  ground,  for 
I  cannot  see  that  we  have  erred.  We  can 
say  to  our  Negro  physicians :  "You  can 
have  scientific  membership.  That  entitles 
you  to  participate,  nominate,  and  vote.  That 
entitles  you  to  all  privileges  except  social 
functions."  Or,  we  can  do  as  other  groups 
have  done.  We  can  leave  this  organization, 
the  Medical  Society  of  the  State  of  North 
Carolina,  exactly  as  it  is  now  and,  without 
change  of  constitution  or  by-laws,  omit  all 
social  functions.  We  can  then,  by  whatever 
maneuver  is  necessary,  make  membership 
in  the  Society  tie  in  with  license  to  practice 
medicine  in  North  Carolina  and  require 
membership  and  regular  attendance  at 
meetings.  Then  we  can  be  assured  of  hav- 
ing our  brethren  with  us  for  scientific  ses- 
sions. If  we  desire  to  have  social  functions, 
and  no  doubt  we  will,  this  can  be  accom- 
plished by  invitation  only  under  the  aus- 
pice of  some  other  organization. 

Other  Considerations 

There  are  other  things  of  which  I  am 
mindful.  The  format  of  our  Annual  Meet- 
ing will  be  changed,  as  authorized  by  the 
House  of  Delegates.  We  will  hold  perhaps 
three  general  sessions  in  the  mornings, 
with  a  program  which  would  have  contin- 
uity of  a  sort  involving  the  areas  of  the 
specialty  sections.  It  would  be  a  broad- 
spectrum  program,  and  participating  in  it 
would  be  surgeons,  internists,  pathologists, 
radiologists,  and  others. 

If  time  permitted,  I  would  discuss  with 
you  in  some  detail  other  matters  of  interest. 
However,  I  will  briefly  mention  one  or  two 
of  most  interest. 

Dr.  Wilburt  Davison,  who  is  soon  to  re- 
tire as  Dean  of  the  Duke  University  School 
of  Medicine,  is  proposing  a  change  in  the 
accepted  plan  for  the  first  year  internship 
in  North  Carolina.  This  plan  would  set  up 
an  acceptable  teaching  and  training  pro- 
gram in  our  better  community  general  hos- 
pitals. Each  of  our  three  medical  schools 
would,  by  agreement,  discontinue  their  one 
year  of  internship  and  run  only  a  residency 


July,   1960 


263 


Amos  N.  Johnson,  M.D. 


264 


NORTH  CAROLINA  MEDICAL  JOURNAL 


July,   1960 


training  program.  This  change  would  chan- 
nel, for  one  year  at  least,  young  doctors 
through  hospitals  whose  major  purpose  is 
to  treat  and  alleviate  disease  and  suffering. 
This  could  give  these  young  men  a  better 
perspective  upon  which  to  decide  their  fu- 
ture interest  and  training  as  physicians. 
Much  work,  salesmanship,  and  persuasion 
will  be  required  if  this  excellent  idea  is  ever 
put  into  practice. 

Dr.  Wingate  Johnson,  editor  of  your 
North  Carolina  Medical  Journal,  has 
assured  me  that  I  will  be  given  a  page  in 


every  issue  of  our  Journal  this  year.  I 
promise  you  that  I  will  use  this  page  in 
each  issue  to  keep  you  abreast  of  problems 
and  progress  of  our  Medical  Society  as  I  see 
them.  Some  ideas  and  proposed  innova- 
tions may  be  controversial;  however,  their 
purpose  will  be  to  escape  from  conformity 
and  mediocrity.  I  will  at  all  times  welcome 
comments  and  ideas  from  all  our  member- 
ship. 

Again    I   am  grateful   to  you   for   permit- 
ting me  the  honor  of  appearing  before  you. 


Bad  Politics  and  Good  Medicine  Don't  Mix 


Louis  M.  Orr,  M.D. 
Orlando,  Florida 


It  was  with  a  certain  amount  of  sorrow 
that  I  read  in  the  newspapers  recently  that 
Congressman  Aime  Forand  will  retire  from 
Congress  at  the  end  of  his  present  term  for 
reasons  of  health.  As  a  newspaper  report 
of  the  story  said :  "His  doctors  wanted  him 
to  quit  two  years  ago."  Of  course,  all  of  us 
hate  to  see  Mr.  Forand  go.  But  on  the 
other  hand,  as  physicians,  we  are  obliged 
to  regret  that  he  did  not  follow  his  doctors' 
advice  two  years  ago. 

Unfortunately,  the  legislation  that  has 
become  identified  with  Mr.  Forand  will  not 
be  retired  with  him.  We  know  that  other 
bills  providing  health  insurance  for  the 
elderly — financed  through  Social  Security — 
will  be  around  Congress  for  some  time  to 
come.  There  seems  to  be  a  general  belief 
among  the  pseudo-philanthropists  in  Wash- 
ing-ton that  the  only  way  to  help  the  aged 
meet  their  medical  and  hospital  bills  is  to 
soak  the  rest  of  the  population  by  raising 
the  Social  Security  taxes.  This  belief  seems 
to  be  so  untouchable  that  it  is  now  an  un- 
official creed  of  some  politicians,  and  any- 
one who  does  not  subscribe  to  it  is  branded 
as  inhuman  and  callous. 

As  you  know,  many  different  bills  have 
been  introduced  in  both  houses  of  Congress 
in  recent  months  to  provide  some  form  of 
help  to  the  elderly.  Those  measures  which 
*veuld  saddle  the  taxpayer  and  wage- 
earner  with  the  bill  are  enthusiastically 
hailed  by  Forand  supporters. 


Presented    at    the    President's    Dinner,    before    Medical    Society 
of    the    State    of    North    Carolina.    Raleigh.    May    10.    1960. 


From  the  midst  of  all  the  politicking  and 
pompous  oratory  surrounding  such  mea- 
sures, one  crude  fact  emerges :  Health  care 
for  the  aged  has  become  a  political  issue, 
and  it  will  be  used  to  campaign  for  votes 
in  the  fall.  Personally,  I  regard  this  as  a 
wretched  example  of  political  expediency. 
It  has  been  obvious  for  several  months 
that,  in  the  absence  of  any  strong  issues, 
the  coming  national  elections  might  be 
rather  dull  this  year.  Consequently,  the 
question  of  health  care  for  the  aged  has 
been  seized  upon  as  a  seemingly  clear-cut 
issue  .  .  .  something  to  get  emotional  about 
.  .  .  something  to  win  votes  with. 

In  the  course  of  all  this,  physicians  in 
general  and  the  American  Medical  Associa- 
tion in  particular  have  been  villified  for 
not  endorsing  these  measures.  Because  we 
oppose  the  Forand  bill  and  similar  mea- 
sures, we  are  called  heartless  scoundrels. 
It  is  implied  that  we  are  fighting  tooth- 
and-nail  to  keep  the  nation's  elderly  in  a 
condition  of  abject  poverty,  without  medi- 
cal care. 

Of  course  this  is  nonsense.  There  is  no 
doubt  that  we  have  opposed  Forand-type 
legislation.  However,  we  have  never  said 
we  opposed  helping  the  aged  meet  their 
medical  and  health  expenses.  While  we  are 
very  willing  to  consider  reasonable  pro- 
posals which  would  result  in  actually  help- 
ing the  aged,  we  can  see  no  reason  why  the 
government  must  pick  the  pockets  of  the 
younger  generation  to  pay  for  the  health 
care  of  the  old  people.  I  make  the  point  of 


July,   1960 


POLITICS  AND  MEDICINE— ORE 


205 


our  willingness  to  consider  sound  measures 
because  it  will  clarify  what  I  plan  to  say- 
in  a  few  minutes. 

This  entire  question  of  government  medi- 
cine is  a  radical  departure  from  the  tradi- 
tions which  raised  the  United  States  to 
such  greatness.  Throughout  history  our 
nation  has  championed  the  voluntary  ap- 
proach to  health  and  medical  care.  Our 
physicians  have  functioned  on  an  unre- 
stricted, private  basis,  either  as  solo  prac- 
titioners or  in  a  group  of  doctors  forming 
a  clinic  or  group  practice.  We  always  have 
spurned  any  form  of  national  compulsory 
health  care. 

In  recent  years,  however,  our  federal 
government  has  been  taking  an  increased 
interest  in  health  and  medical  matters. 
This  interest  has  manifested  itself  along 
lines  we  are  convinced  would  be  dangerous 
for  the  health  of  the  nation.  For  example, 
just  since  1953  a  total  of  2,194  health  and 
medical  bills  have  been  introduced  in  Con- 
gress. This  total  does  not  include  those  that 
already  have  been  introduced  and  will  be 
offered  in  the  second  session  of  the  present 
Congress. 

Veterans'  Medical  Care  Program 

I  could  list  any  number  of  examples  of 
the  growing  interest  of  Congress  in  health 
matters,  but  let  us  start  with  the  veterans' 
medical  care  program  in  the  United  States. 
Let  us  take  a  quick  look  at  what  has  hap- 
pened. 

The  original  motive  for  this  program 
was  the  desire  to  provide  care  for  any  vet- 
eran who  had  become  disabled  while  serv- 
ing his  country.  Such  a  desire  was,  and 
still  is,  a  sound,  humanitarian  motive  and 
a  legitimate  obligation  of  the  federal  gov- 
ernment. Over  the  last  35  years,  however, 
the  program  has  been  expanded  to  provide 
care  for  the  veteran  who  suffers  a  dis- 
ability after  his  discharge  from  service 
and  one  that  has  no  relation  to  his  military 
duty.  The  reasons  for  this  expansion  can 
be  traced  to  politically  motivated  acts  of 
our  Congress,  as  well  as  to  vigorous  pres- 
sure by  lobbying  organizations. 

In  1917  legislation  was  first  passed  to 
provide  medical  services  and  supplies  to 
veterans  with  service-connected  disabilities. 
Six  years  later  Congress  broke  the  ice  and 
authorized  care  for  non-service-coymected 
cases,  because  some  beds  had  become  avail- 


able through  a  reduction  in  the  load  of  pa- 
tients with  service-connected  conditions. 
This  provision  applied  only  to  certain 
veterans. 

A  year  later,  the  doors  were  opened 
wider  to  include  more  veterans.  Within  two 
years  (1926)  17  per  cent  of  all  patients  in 
veterans  hospitals  were  receiving  treat- 
ment for  diseases  or  injuries  not  related  to 
military  service.  And  in  that  year  the 
doors  to  the  veterans  hospitals  were  swung 
completely  open. 

Two  years  later  (by  1928)  49  per  cent 
of  all  admissions  were  for  non-service- 
connected  cases.  By  1931  this  figure  had 
jumped  to  71  per  cent.  In  1954  more  than 
83  per  cent  of  the  patients  discharged  from 
veterans  hospitals  had  disabilities  not  con- 
nected with  military  service. 

During  the  last  30  years  the  argument 
for  care  for  non-service-connected  cases 
has  been  that  as  long  as  extra  or  vacant 
beds  are  available,  the  beds  should  be  used 
for  indigent  veterans  who  have  non-service- 
connected  disabilities  or  illnesses.  Well,  30 
years  ago  our  nation  had  only  9,500  "ex- 
tra" beds.  Today  there  are  more  than 
80,000. 

The  VA  costs  have  skyrocketed  from  37 
million  dollars  in  1934  to  843  million 
dollars  in  1959.  Perhaps  even  more  impor- 
tant than  the  cost  of  this  particular  fed- 
eral program,  however,  is  the  development 
of  greater  federal  control  of  our  medical 
schools  as  the  private  teaching  hospitals 
drop  internships  and  residencies  because 
of  inability  to  compete  with  the  VA  hospi- 
tal inducements.  And  these  are  paid  for  by 
our  tax  dollars.  I  fear  that  federal  pro- 
grams such  as  this  can  lead  to  a  large  num- 
ber of  physicians  whose  total  hospital  ex- 
perience during  their  education  will  have 
been  under  the  federal  eye — from  clinical 
clerkship  to  completion  of  residency. 

There  are  many,  many  more  problems 
connected  with  the  veterans  program,  but 
to  examine  each  would  take  considerable 
time.  From  this  brief  discussion,  however, 
you  get  some  idea  of  the  error  in  allowing 
the  federal  government  to  expand  a  legiti- 
mate program  until  it  "covers  the  water- 
front." 

Health  Plans  and  Social  Security 
As  I  mentioned  earlier,  one  of  our  major 
reasons  for  opposing  Congressional   health 


2lil> 


NORTH  CAROLINA   MEDICAL  JOURNAL 


July,   I960 


schemes  is  because  they  would  be  operated 
under  the  Social  Security  Administration. 

When  the  Social  Security  Act  became 
law  in  1935,  it  contained  15  titles  covering 
a  wide  range  of  subjects,  including  old  age 
"insurance,"  aid  to  the  blind,  aid  to  de- 
pendent and  crippled  children,  aid  to  the 
needy  aged,  grants  for  maternal  and  child 
welfare,   and    unemployment    compensation. 

The  A.M. A.  has  not  taken  any  position 
before  or  since  1935  about  the  wisdom  or 
desirability  of  the  over-all  Social  Security 
program.  In  fact,  the  act  might  never  have 
become  a  matter  of  concern  to  the  medical 
profession  had  it  remained  in  or  near  its 
original  form. 

The  act  was  amended  drastically  in  1939, 
particularly  in  regard  to  Title  II,  which 
covered  old  age  insurance  programs.  Few 
substantial  changes  were  made  between 
1939  and  1950.  Since  then,  however,  the 
act  has  been  amended  substantially  in 
every  election  year — 1952,  1954,  1956,  and 
1958. 

The  original  provisions  of  Title  II  were 
designed  to  compel  the  employed  worker  to 
set  aside  a  certain  amount  of  his  earnings 
for  his  old  age.  It  applied  primarily  to 
workers  in  commerce  and  industry.  The  act 
did  not  and  was  not  intended  to  cover  self- 
employed  persons,  farmers  or  professional 
people,  among  others. 

Title  II  was  originally  limited  to  lump 
sum  death  benefits  and  monthly  old  age 
payments  for  covered  employes  who  had 
paid  into  the  system.  Four  years  after 
adoption,  the  act  was  amended  radically  to 
allow  monthly  benefits  for  dependents  and 
survivors. 

In  1950  some  10  million  workers  were 
brought  under  the  protective  wings  of  the 
Social  Security  Act,  and  in  1954  coverage 
was  forced  on  farmers,  lawyers,  dentists, 
and  additional  farm  and  domestic  em- 
ployes. State  and  local  government  em- 
ployes, ministers,  and  members  of  religious 
orders  were  offered  a  means  to  accept  cov- 
erage voluntarily. 

The  only  large  groups 
by  the  act  are  federal 
ployes — who  have  their 
program — and  physicians. 

The  A.M. A.  has  opposed  inclusion  of 
physicians  for  philosophic  and  economic 
reasons.     Our    philosophic    arguments    are 


not  now  covered 
government  em- 
own     retirement 


based  on  the  theory,  history  and  long-range 
prospects  for  social  insurance  systems.  In 
other  countries,  such  schemes  have  grown 
from  retirement  payments  to  survivorship 
payments  to  temporary  cash  sick  benefits, 
and  finally  to  national  compulsory  health 
insurance. 

In  the  United  States,  Social  Security  is 
following  the  same  pattern.  It  has  pro- 
gressed farther  and  farther  away  from  its 
original  purpose  of  providing  financial 
protection  for  aged  citizens  and  has  moved 
closer  and  closer  to  the  paternalistic,  gov- 
ernment concept  of  "womb-to-tomb"  cov- 
erage. 

Economically,  few  physicians  would  bene- 
fit from  the  retirement  features  of  Social 
Security  since  most  doctors  continue  work- 
ing long  after  their  sixty-fifth  birthdays. 
We  in  the  A.M. A.  also  feel  that  our  ap- 
proval of  compulsory  coverage  would  tend 
to  dilute  the  strength  of  our  continuing 
struggle  against  government  medicine  via 
amendments  to  the  Social  Security  Act.  It 
is  well  known  that  advocates  of  federal 
medicine  have  long  envisioned  the  act  as  a 
vehicle  for  providing  all-embracing  gov- 
ernment health  care.  This  ultimate  objec- 
tive was  openly  presented  to  Congress  in 
1943  when  a  national  health  insurance  bill 
was  introduced.  Although  it  was  not 
passed,  versions  of  this  1943  legislation 
have  been  presented  in  every  Congress 
since  then. 

From  1948  to  1951  the  bills  received 
their  greatest  attention.  It  took  a  long  and 
active  campaign  against  this  type  of  legis- 
lation by  the  medical  profession  and  num- 
erous other  groups  to  convince  Congress 
that  Americans  wanted  no  part  of  govern- 
ment medicine. 

Government  Medicine  vs. 
Voluntary  Insurance 

In  our  country,  the  government's  medi- 
cal activities  are  on  a  massive  scale,  and 
they  continue  to  grow.  Last  year  for  all 
health  programs — research,  medical  care, 
public  health — the  government  spent  62 
per  cent  more  than  it  did  five  years  before. 
Programs  in  22  separate  agencies  and  de- 
partments of  the  U.  S.  government  range 
from  cancer  research  to  federal  employee 
clinics.  The  total  cost  last  year  was  about 
2  3/4  billion  dollars. 


I 


July,   1960 


POLITICS  AND  MEDICINE— ORR 


267 


Today  nearly  38  million  persons  are  eli- 
gible to  receive  all  or  part  of  their  medical 
care  from  or  through  the  federal  govern- 
ment. Both  as  a  physician  and  as  a  tax- 
payer, I  would  like  to  know  where  this  is 
going  to  stop ! 

In  our  country,  nearly  125  million  per- 
sons have  some  form  of  voluntary,  non- 
government health  insurance.  This  is  about 
five  out  of  every  seven  persons.  And  more 
and  more  persons  are  signing  up  for  such 
health  insurance  coverage. 

So  you  see,  this  coin  has  two  sides — on 
one  side  the  federal  government  is  expand- 
ing its  activities  in  the  medical  care  field, 
while  on  the  other  voluntary  methods  are 
providing  more  and  better  non-government 
health  insurance  for  Americans. 

The  American  Medical  Association  be- 
lieves the  voluntary  system  should  be  al- 
lowed to  function  freely  and  to  provide  for 
the    health    care    needs    of    the    American 


people.  Our  opponents  sit  back  and  whine: 
"Let  the  government  do  it." 

The  medical  profession,  along  with  its 
many  allies  in  the  health  field,  is  trying  to 
halt  the  current  piecemeal  attempts  to 
bring  complete  federal  control  of  medical 
care  and  the  medical  profession.  Already 
our  opponents  have  made  far  too  many 
gains,  and  the  struggle  has  become  a  "do 
or  die"  fight  to  keep  the  private  practice 
of  medicine  alive  in  the  United   States. 

Conclusion 
This,  then,  is  the  situation.  I  can  promise 
you  the  A.M. A.  will  do  all  in  its  power  to 
maintain  the  free  enterprise  system,  the 
private  practice  system,  and  the  voluntary 
approach  to  health  and  medical  care.  We 
will  do  so  because  these  methods  have 
brought  to  the  American  people  the  highest 
possible  degree  of  medical  care  and  knowl- 
edge, and  it  will  bring  them  even  greater 
care  in  the  future. 


Three  Great  Challenges 

Leonard  W.  Larson,  M.D.* 
Bismark,  North  Dakota 


As  you  know,  American  medicine  is  en- 
tering into  a  decade  that  may  be  its  great- 
est— or  its  most  disastrous.  I  am  sure  you 
are  well  aware  of  the  innumerable  chal- 
lenges and  problems  that  lie  ahead  of  us, 
many  requiring  our  immediate  attention.  I 
want  to  speak  about  three  of  these  chal- 
lenges. 

Medical  Education 

One  which  requires  careful  study  and 
the  positive  approach  is  the  task  of  improv- 
ing both  the  quality  and  the  quantity  of 
our  medical  education  facilities.  Here,  we 
must  plan  ahead  to  maintain  an  adequate 
supply  of  well  trained  physicians  to  meet 
the  future  medical  needs  of  the  American 
people. 

For  the  past  30  years  or  more,  the  pro- 
duction of  new  physicians  by  our  medical 
schools  has  kept  up  with  the  nation's  grow- 
ing population.  Times  are  changing,  how- 
ever,   and    we    cannot    be    complacent.    Our 


Read  before  the  House  of  Delegates,  Medical  Society  of  the 
State    of    North    Carolina.    Raleigh.    May    9.    1960. 

♦Chairman  of  the  Board  of  Trustees.  American  Medical 
Association. 


population  is  increasing.  Medical  knowl- 
edge is  expanding.  Medical  services  are  be- 
coming more  complex.  And  the  American 
people  are  showing  greater  interest  in  both 
the  quality  and  availability  of  health 
services. 

In  recent  years  there  have  been  a  num- 
ber of  governmental  and  private  studies 
involving  the  nation's  future  needs  in  med- 
ical manpower.  These  studies  have  pre- 
dicted approximately  the  numbers  of  phy- 
sicians and  medical  schools  required  by 
1975  and  thereafter.  Opinions  differ  on  the 
variety  of  statistics  and  estimates,  but 
there  is  agreement  on  the  need  for  con- 
structive planning  to  meet  future  require- 
ments. Undoubtedly,  it  will  be  necessary  to 
increase  the  annual  number  of  medical 
school  graduates. 

In  December,  1958,  the  A.M. A.  House  of 
Delegates  adopted  a  statement  on  the  ex- 
pansion of  American  medical  education. 
Existing  medical  schools  were  urged  to  con- 
sider increasing  their  enrollments  and  de- 
veloping new  facilities.  The  House  also  en- 
couraged   the    creation    of    new    four-year 


268 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July.   1960 


medical  schools  and  two-year  basic  science 
programs  by  universities  which  can  pro- 
vide the  proper  academic  and  clinical  set- 
ting. This  expansion,  the  House  empha- 
sized, should  be  based  upon  careful,  con- 
tinuing study  of  the  changing  needs  in  all 
categories  of  medical  activity. 

In  addition,  the  American  Medical  As- 
sociation is  encouraging  medical  schools  to 
experiment  in  new  programs  aimed  at 
bringing  about  continual  improvement  in 
the  quality  and  content  of  their  curricula. 
For  example,  the  new  medical  school  stand- 
ards approved  in  June,  1957,  are  intended 
to  provide  flexible  guides  which  will  dis- 
courage excessive  concern  with  standariza- 
tion,  but  which  also  will  stimulate  each 
medical  faculty  to  provide  a  well  integrated 
educational  program  in  accordance  with  its 
own  particular  setting. 

Recruitment 

Meanwhile,  the  A.M. A.  has  developed  an 
expanded  career  guidance  program  to  re- 
cruit qualified,  dedicated  young  people  into 
the  study  of  medicine.  There  is  definite 
need  for  more  intensive  effort  along  these 
lines — from  the  national  level  all  the  way 
down  to  the  grass  roots  of  the  doctor's 
home  town  or  neighborhood. 

Too  many  superior  students  are  attracted 
by  other  sciences  which,  in  this  age  of 
electronics,  nuclear  energy  and  space  ex- 
ploration, may  seem  more  exciting  or  glam- 
orous. Others  are  drawn  to  careers  which 
may  appear  to  be  more  lucrative  or  more 
easily  attained,  or  less  demanding.  Many 
of  these  young  people  are  discouraged  by 
the  length  and  cost  of  a  medical  education. 

Recruitment  and  expansion  in  medical 
education  are,  of  course,  closely  related 
problems.  Recognizing  this  at  the  Dallas 
meeting  last  December,  the  A.M. A.  House 
of  Delegates  approved  the  creation  of  a 
special  committee  to  "present  a  scholarship 
program,  its  development,  administration 
and  the  role  of  the  American  Medical  As- 
sociation in  fulfilling  it."  Such  a  program 
also  could  include  provision  for  student 
loans. 

The  same  committee  will  study  these 
seven  other  major  questions: 

— How  far  can  medical  schools  expand 
their  student  bodies  while  still  maintaining 
a  high  quality  of  medical  education? 

— What  universities  can  support  new 
medical  schools  with  qualified  students  and 


sufficient  clinical  material  for  teaching — 
either  on  a  two-year  or  a  full  four-year 
basis? 

— How  to  obtain  competent  medical  fac- 
ulties? 

— How  to  finance  the  expansion  and  es- 
tablishment of  medical  schools? 

— How  to  finance  medical  education  in 
the  most  economical  ways  commensurate 
with  high  quality  training? 

— How  to  recruit  well  qualified  students 
into  the  study  of  medicine  .  .  .  and,  finally, 

— What  are  the  possibilities  of  relaxing 
some  of  the  geographic  restrictions  which 
affect  the  admission  of  medical  school  stu- 
dents? 

This  new  committee  was  asked  to  make 
its  first  report  at  the  A.M. A.  June  meeting. 

I  urge  you  and  the  entire  profession — 
practicing  physicians,  teachers,  adminis- 
trators, researchers,  medical  societies,  pub- 
lic health  personnel,  and  medical  schools — 
to  give  full  cooperation  to  this  study. 
Through  all  possible  channels  I  hope  that 
you  will  make  your  ideas  and  suggestions 
available  for  this  long-range  project  aimed 
at  the  continuing  improvement  of  Ameri- 
can medical  services. 

Third  Parties 

Still  another  challenge  to  all  of  us  is  the 
task  of  bringing  about  better  understand- 
ing and  cooperation  between  medicine  and 
the  various  third  parties  involved  in  med- 
ical care  plans  and  health  insurance. 

You  may  recall  that  last  June  the  A.M. A. 
House  of  Delegates,  in  acting  upon  the 
recommendations  of  the  Commission  on 
Medical  Care  Plans,  adopted  these  key 
statements  on  freedom  of  choice  of  physi- 
cian : 

The  American  Medical  Association  believes 
that  free  choice  of  physician  is  the  right  of 
every  individual  and  one  which  he  should  be  free 
to  exercise  as  he  chooses. 

Each    individual    should    be   accorded    the    priv- 
ilege to  select  and   change   his   physician   at  will 
or    to    select    his    preferred    system    of    medical 
care,     and     the     American     Medical     Association 
vigorously   supports    the    right    of    the    individual 
to   choose   between  these   alternatives. 
Those  statements  were  reaffirmed  at  the 
Dallas  meeting  last  December.   Some  mem- 
bers  of  the   profession   felt,   however,  that 
there  had  been  a  certain  degree  of  misun- 
derstanding   or    misinterpretation     of    the 


July,   1960 


THREE  CHALLENGES— LARSON 


269 


action  taken  last  June.  Therefore,  at  the 
Dallas  meeting,  in  order  to  clarify  and 
strengthen  its  position  on  the  issue  of  free- 
dom choice,  the  House  also  adopted  this 
additional  statement: 

Lest  there   be   any   misinterpretation,   we   state 
unequivocally   that   the    American    Medical    Asso- 
ciation  firmly    subscribes    to    freedom    of    choice 
of   physician    and    free    competition    anions:    phy- 
sicians   as    being    prerequisites    to    optimal    med- 
ical care.  The  benefits  of  any  system  which  pro- 
vides medical  care  must  be  judged  on  the  degree 
to  which  it  allows  of,  or  abridges,  such  freedom 
of  choice  and  such  competition. 
In   other   words,   the   medical    profession 
recognizes    a    person's   right    to   choose  the 
kind   of  medical    care    plan    he    wants — in- 
cluding a   closed   panel   plan.    At   the   same 
time  we  believe  emphatically  that  the  best 
medical  care  comes  about  when  the  patient 
has  maximum   freedom    of   choice   and    the 
doctor   has    maximum    freedom    of    profes- 
sional action.  I  think,  however,  that  all   of 
us  must  do  a  much  better  job  of  explaining 
to   the    public,    and    to    those    who    sponsor 
medical  care  or  health  insurance  programs, 
just  why  these  principles  are  vital  to  high 
quality  medical  service. 

I  urge  you  to  cooperate  sincerely  in  all 
national,  state  and  local  activities  aimed  at 
bringing  about  better  understanding.  In  my 
opinion,  all  of  us  should  bear  in  mind  that 
labor  unions,  industry,  and  other  third 
parties  in  the  medical  care  field  are  trying 
to  meet  a  need  under  our  American  system 
of  private  enterprise.  It  seems  to  me  that 
all  of  us — despite  differences  of  opinion  on 
certain  points — should  be  working  together 
in  the  fight  against  a  common  danger :  gov- 
ernment encroachment  which  ultimately 
could  destroy  our  entire  system  of  private 
medicine  and  voluntary  health  insurance. 

Physician-Hospital  Relationships 

Another  difficult  issue  which  concerns 
the  entire  medical  profession  is  the  problem 
of  physician-hospital  relationships.  I  would 
not  attempt  to  cover  all  the  complexities 
and  variations  of  this  subject,  but  again  I 
ivoidd  like  to  report  to  you  on  the  latest 
policy  developments  in  this  area. 

1951  Guides  for  Conduct 

The  A.M.A.  House  of  Delegates,  at  the 
Dallas  meeting  received  a  dozen  resolutions 
on  the  subject  of  physician-hospital  rela- 
tionships. The  House  did  not  act  upon  any 


of  those  resolutions.  Instead,  to  remove  any 
doubt  about  its  position,  the  House  reaf- 
firmed the  1951  "Guides  for  Conduct  of 
Physicians  in  Relationships  with  Institu- 
tions." It  also  declared  that  "all  subsequent 
or  inconsistent  actions  are  considered  su- 
perceded." 

If  I  may,  I  should  like  to  refresh  your 
memories  by  quoting  just  three  brief  para- 
graphs of  those  1951  guides.  They  sum- 
marize general  principles  which  should  be 
used  as  a  basis  for  adjusting  controversies. 
Again  I  quote : 

1.  A  physician  should  not  dispose  of  his  pro- 
fessional attainments  or  services  to  any  hospital, 
corporation  or  lay  body  by  whatever  name  called 
or  however  organized  under  terms  or  conditions 
which  permit  the  sale  of  the  services  of  that 
physician  by  such  agency  for  a  fee. 

2.  Where  a  hospital  is  not  selling  the  services 
of  a  physician,  the  financial  arrangement  if  any 
between  the  hospital  and  the  physician  properly 
may  be  placed  on  any  mutually  satisfactory 
basis.  This  refers  to  the  remuneration  of  a  phy- 
sician for  teaching  or  research  or  charitable 
services  or  the  like.  Corporations  or  ■ither  lay 
bodies  properly  may  provide  such  services  and 
employ  or  otherwise  engage  doctors  for  those 
purposes. 

3.  The  practice  of  anesthesiology,  pathology, 
physical  medicine  and  radiology  are  an  integral 
part  of  the  practice  of  medicine  in  the  same 
category  as  the  practice  of  surgery,  internal 
medicine  or  any  other  designated  field  of  medi- 
cine." 

In  addition  to  reaffirming  the  1951 
guides,  the  A.M.A.  House  of  Delegates 
recommended  that  the  medical  profession 
strengthen  relationships  with  hospitals  by 
action  at  state  and  local  levels.  And,  finally, 
it  also  urged  the  A.M.A.  Board  of  Trustees 
to  continue  to  maintain  liaison  with  the 
American  Hospital  Association's  Board  of 
Trustees. 

This  is  a  highly  complex  issue  with  legal 
and  professional  ramifications  which  vary 
greatly  in  different  states  and  communities. 
In  my  own  view,  our  best  hope  for  sound, 
lasting  solutions  would  be  in  developing 
effective  liaison  between  physicians  and 
hospitals  at  the  state  and  local  levels. 

Both  of  us — physicians  and  hospitals — 
must  think  primarily  of  public  welfare  and 
community  responsibility.  At  the  same 
time,  we  doctors  have  a  duty  to  protect 
those    ethics   and    traditions   which    contri- 


270 


NORTH  CAROLINA  MEDICAL  JOURNAL 


July,   1960 


bute  to  high  quality  medical  care,  and 
which  safeguard  the  patient  against  all 
possible  kinds  of  exploitation. 

I  hope  that  physicians  everywhere  will 
work  especially  hard  to  help  bring  about 
better  communication  and  understanding 
on  the  state  and  local  level. 


Conclusion 

Among  the  many  challenges  facing  medi- 
cine, I  have  outlined  but  three — expansion 
of  our  medical  education  system,  relation- 
ships with  third  parties,  and  physician-hos- 
pital relations. 

I  am  confident  that  my  fellow  physicians 
in  North  Carolina  will  measure  up  to  these 
long,  hard  tasks  ahead. 


Generalized  Salivary  Gland  Virus  Disease 
In  Post>neonatal  Life 


Charles  F.  Gilbert,  M.D. 
Chapel  Hill 


The  clinical  and  pathologic  features  of 
generalized  salivary  gland  virus  disease  in 
the  newborn  and  adult  are  well  known.  It 
is  not  so  well  known  that  the  disease  has  a 
post-neonatal  phase  in  which  the  clinical 
and  pathologic  features  have  not  been  well 
denned.  This  hiatus  in  knowledge  is  due  in 
part  to  the  rarity  with  which  the  disease 
occurs  in  this  age  group.  The  following 
case  is  reported  to  emphasize  some  features 
of  the  post-neonatal  phase  of  the  disease 
and  to  indicate  certain  diagnostic  methods 
which  have  been  recently  described. 

Neonatal  Form 

The  disease  in  the  neonatal  age  group 
has  two  distinct  forms.  The  first  is  asymp- 
tomatic involvement  of  the  salivary  glands, 
which  is  found  in  10  to  30  per  cent  of  un- 
selected  autopsies.  The  second  is  the  dis- 
seminated form,  which  presents  a  char- 
acteristic clinical  picture  and  has  an  espe- 
cially high  incidence  in  premature  infants. 
The  characteristic  findings  are  jaundice, 
hepatosplenomegaly,  cutaneous  petechiae, 
anemia  and  thrombocytopenia,  which  are 
present  at  birth  or  develop  within  the  next 
few  days.  The  virus  is  pantropic,  involving 
the  kidneys,  liver  and  lungs  more  common- 
ly, but  frequently  is  present  in  the  brain, 
pancreas,  thyroid,  gut  or  other  organs.  The 
mode  of  dissemination  is  thought  to  be 
transplacental,  occurring  early  in  the  ges- 
tation. The  mechanism  liberating  the  virus 
from  the  mother's  salivary  glands  and  caus- 
ing the  maternal  and  fetal  viremia  is   un- 


From     the     Department    of     Pathology.     University     of    North 
Carolina    School   of    Medicine.    Chapel    Hill. 


known.  An  interesting  feature  is  that  the 
fetal  organs  receiving  a  large  amount  of 
blood  are  involved  more  frequently  and 
more  extensively.  The  prognosis  in  the  dis- 
seminated disease  is  grave  in  contrast  to 
that  in  the  localized  or  asymptomatic  forms. 

Adult  Form 
Disseminated  salivary  gland  virus  dis- 
ease is  extremely  uncommon  in  adults, 
only  35  cases  having  been  published  in  the 
world  literature*1'.  The  disease  has  been  re- 
ported only  as  a  complication  of  a  chronic 
debilitating  disease  or  its  treatment.  A  pri- 
mary neoplasm  of  the  reticuloendothelial 
system,  refractory  anemia,  leukemia,  renal 
disease,  and  other  less  common  debilitating 
diseases  have  been  associated  with  a  ma- 
jority of  reported  cases.  The  symptoms  of 
the  adult  form  are  those  of  the  primary 
disease  and  of  respiratory  distress  second- 
ary to  an  interstitial  pneumonia  caused 
by  the  salivary  gland  virus.  The  pneumonia 
in  many  cases,  both  adult  and  neonatal,  is 
associated  with  an  infestation  by  Pneumo- 
cystis carinii.  This  latter  organism  is 
thought  to  be  a  protozoan,  but  its  classifica- 
tion is  uncertain.  It  is  associated  with 
salivary  gland  virus  disease  in  up  to  50  per 
cent  of  cases. 

Post-neonatal  Form 
The  disease  in  this  age  group  differs 
somewhat  from  that  of  the  newborn  and 
the  adult.  It  usually  presents  as  a  severe 
respiratory  infection  or  gastroenteritis. 
Renal  and  hepatic  dysfunction  occur,  but 
are  less  common.  The  disease  is  usually 
manifest  between  2  and  4  months  of  age, 


July,   19G0 


SALIVARY  GLAND  VIRUS  DISEASE— GILBERT 


271 


r 


but  has  a  range  of  3  weeks  to  32  months'2'. 
Prematurity  has  not  been  correlated  with 
the  development  of  the  disease.  As  in  the 
neonatal  group,  there  has  been,  to  date,  an 
unrelenting  progression  of  symptoms  until 
death,  which  may  be  as  long  as  two  or 
three  months. 

The  organ  involvement  in  this  age  group 
is  similar  to  that  of  the  newborn.  The  lungs, 
kidneys,  and  liver  are  commonly  affected, 
and  other  organs  less  frequently.  As  in  the 
present  case,  the  clinical  picture  is  not  well 
denned,  but  the  disease  should  be  suspected 
in  children  with  an  unremitting  pneumonia 
or  gastrointestinal  disturbance,  especially  if 
hepatosplenomegaly  accompanies  either. 

Development  of  the  fulminant  disease 
in  newborn  infants  is  apparently  related  to 
the  fetal  viremia  and  the  inability  of  the 
infant  to  produce  antibodies.  The  same 
factors  may  be  present  in  adults  with  a 
chronic  debilitating  disease.  Most  cases  in 
the  post-neonatal  period  apparently  have  no 
precipitating  illness. 

Case  Report 

The  patient  was  a  12  month  old  white 
girl  referred  to  North  Carolina  Memorial 
Hospital  because  of  stiffness  and  weakness 
of  the  right  arm  and  leg  observed  since  the 
age  of  3  months.  There  had  also  been  fail- 
ure to  attain  normal  muscular  development 
and  skill. 

The  child  was  the  product  of  a  normal 
pregnancy,  but  during  the  nine-hour  labor 
arrest  occurred,  and  she  was  delivered  with 
low  forceps.  She  cried  spontaneously  and 
her  color  was  good.  The  mother  and  father 
were  healthy  and  had  no  other  children. 

On  the  first  clinic  visit,  at  12  months  of 
age,  she  weighed  21  V->  pounds  and  was  30% 
inches  in  length.  The  head  circumference 
was  16  1/4  inches,  slightly  below  the  third 
percentile  for  her  age.  The  right  elbow  and 
knee  were  flexed,  and  spasticity  was  pre- 
sent in  these  limbs.  The  right  leg  was  y2 
inch  shorter  than  the  left,  but  mobility  at 
the  hip  joints  was  normal.  There  was  a  pos- 
sible homonymous  hemianopsia  on  the  right. 
An  electroencephalogram  had  evidence  of 
left  cerebral  damage. 

The  patient  returned  at  14  months  of  age 
because  of  seizures  characterized  by  sudden 
dropping  forward  from  a  sitting  position, 
turning  of  the  head  toward  the  left,  and 
clonic  motions  of  the  left  leg.  These  lasted 


about  30  seconds.  Occasionally  vomiting 
followed.  The  seizures  had  begun  12  days 
prior  to  this  visit,  and  occurred  about  five 
times  a  clay  for  the  first  five  days,  and 
thereafter  about  every  half  hour.  The  fam- 
ily physician  had  prescribed  phenobarbital, 
following  which  the  seizures  became  less 
frequent.  The  physical  findings  were  un- 
changed. Because  the  seizures  had  contin- 
ued to  occur,  the  dosage  of  phenobarbital 
was  increased  and  Dilantin  was  also  pre- 
scribed. 

She  was  admitted  to  this  hospital  at  15 14 
months  of  age  because  of  an  "urticarial- 
like"  rash  and  fever  which  had  been  pre- 
sent for  the  previous  11  days.  The  rash  had 
begun  over  the  neck  and  upper  trunk  and 
finally  spread  over  most  of  the  body.  Dilan- 
tin was  discontinued  four  days  after  the 
rash  developed.  About  three  days  before 
admission  her  throat  became  red  and  she 
began  to  cough  frequently.  The  white  cell 
count  then  was  16,750,  with  51  per  cent 
segmented  forms  and  47  per  cent  lympho- 
cytes. She  had  retained  little  food.  Her 
bowel  movements  had  become  more  fre- 
quent and  softer  than  usual,  and  she  had 
urinated  only  twice  a  day  for  the  previous 
three  days.  Her  feet  were  swollen. 

On  admission  the  temperature  was  101  F., 
pulse  110/min.,  respirations  20/min.  and 
the  weight  was  20  pounds.  The  skin  was 
covered  with  a  partly  confluent  erythema- 
tous macular  rash,  with  beginning  desqua- 
mation in  the  diaper  area.  Axillary  and  in- 
guinal lymph  nodes  were  slightly  enlarged. 
The  lungs  were  clear  despite  frequent 
coughing.  The  liver  had  descended  5  cm. 
below  the  right  costal  margin.  The  hands 
and  feet  were  moderately  edematous.  The 
neurologic  findings  had  not  changed. 

The  hematocrit  was  47  per  cent,  and  the 
leukocyte  count  was  45,250  mm3,  with  48 
per  cent  granulocytes,  25  per  cent  lympho- 
cytes and  17  per  cent  monocytes.  Many  of 
the  monocytes  and  lymphocytes  were  atyp- 
ical and  questionably  immature.  A  test  (fer- 
ric chloride)  for  phenylpyruvic  acid  in  the 
urine  was  negative.  A  trace  of  albumin  was 
present  in  the  urine,  with  10  to  15  leuko- 
cytes and  an  occasional  erythrocyte.  A 
growth  of  Escherichia  coli  was  obtained 
from  the  urine  culture.  X-ray  films  of  the 
skull  were  interpreted  as  showing  micro- 
crania. 


272 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July,   1960 


Hospital  course 

Hydrocortisone  and  intravenous  fluids 
were  given  and  improvement  occurred  dur- 
ing- the  initial  few  days.  After  about  two 
weeks,  however,  the  patient  began  having 
up  to  18  watery  stools  a  day.  The  main 
problem  during  the  remainder  of  her  life 
was  that  of  hydration  and  electrolyte  bal- 
ance. The  dermatitis  improved  at  times, 
but  eventually  progressed  to  exfoliation, 
with  superimposed  bullous  eruptions.  On 
one  occasion  hemorrhagic  vesicular  lesions 
were  present  on  the  hands,  arms,  feet,  buc- 
cal mucosa,  and  lips.  Phenobarbital  had 
been  discontinued  on  admission,  but  there 
were  no  more  seizures.  In  addition  to  ster- 
oids and  intravenous  fluids,  she  was  given 
antibiotics  and  intravenous  salt-poor  albu- 
min and  blood.  Despite  all  efforts  and  med- 
ication, her  condition  slowly  deteriorated. 
During  the  three  months'  hospitalization 
the  blood  urea  nitrogen  rose  from  3  to  22 
mg.  per  100  ml.,  the  hematocrit  decreased 
to  35  per  cent,  and  the  leukocyte  count  re- 
verted to  normal.  Platelets  were  present  on 
all  peripheral  blood  smears.  Weight  de- 
creased to  12  pounds,  although  edema  of 
the  extremities  appeared  to  increase.  The 
total  proteins  were  5.4  Gm.  per  100  ml. 
with  an  albumin  of  2.8  Gm.  per  100  ml.  On 
the  day  before  death  pulmonary  edema  and 
tachycardia  developed  and  she  became  cy- 
anotic about  the  lips.  Following  the  admin- 
istration of  digoxin,  morphine  and  oxygen, 
some  improvement  was  noted,  but  she  died 
shortly  afterwards  in  apparent  congestive 
heart  failure. 

Autopsy  findings 

At  autopsy  the  body  was  markedly  ca- 
chetic. Extensive  areas  of  exfoliative  der- 
matitis were  scattered  over  the  trunk  and 
limbs;  these  were  especially  marked  over 
the  scalp.  The  lesions  were  slightly  de- 
pressed and  covered  with  a  reddish-brown 
crust.  The  epidermis  was  lost  in  many 
fields  and  was  replaced  by  a  fibrinopurulent 
exudate  containing  gram  positive  cocci.  In 
adjacent  zones,  vesicle  formation  and  loss 
of  the  normal  epidermal  pattern  were  pre- 
sent. A  chronic  cellulitis  was  present  in  all 
areas  examined.  Neither  intranuclear  nor 
cytoplasmic  inclusion  bodies  were  present 
in  any  section  of  skin. 

Each  pleural  space  contained  10  cc.  of 
serous  fluid,  but  no  adhesions.  The  lungs 
were  slightly  heavy  and  remained  distended 


after  removal  from  the  cavity.  The  pleural 
surfaces  were  normal.  The  cut  surfaces  of 
the  lungs  were  wet  and  exuded  a  slight 
amount  of  frothy  fluid  on  compression.  A 
generalized  chronic  interstitial  pneumonia 
with  focal  areas  of  atelectasis  was  present. 
Scattered  throughout  the  alveolar  spaces 
were  large  cells  measuring  30  to  40  micra 
in  diameter  (figs.  1,  2).  They  contained  dis- 
tinct oval  or  rounded  nuclear  inclusion 
bodies  which  were  about  10  micra  in  di- 
ameter and  surrounded  by  an  optically 
clear  halo.  The  cytoplasm  was  eosinophilic 
and  contained  irregular  basophilic  inclu- 
sion bodies.  The  inclusion  bodies  stained 
well  with  hematoxylin  and  eosin. 

The  heart  and  great  vessels  were  normal. 

The  abdominal  organs  were  grossly 
normal  but  small  for  the  patient's  age.  The 
liver  had  a  normal  lobular  pattern,  but 
contained  many  small  foci  of  hematopoietic 
cells.  Intranuclear  or  cytoplasmic  inclusion 
bodies  were  not  found. 

The  kidneys  were  normal  grossly,  but  the 
anatomic  pattern  was  that  of  a  newborn 
infant :  the  glomerular  tufts  were  com- 
posed mainly  of  large  cuboidal  cells  rather 
than  the  flattened  epithelium  seen  in  nor- 
mal infants  of  this  age.  The  epithelial  layer 
of  most  capsules  was  composed  of  similar 
cells.  Many  of  the  tubules  were  dilated,  and 
in  some  fields  the  epithelial  cells  were  large 
and  contained  intranuclear  and  cytoplasmic 
inclusion  bodies  identical  to  those  described 
in  the  lungs  (fig.  3).  The  inclusions  were 
less  frequent  than  in  the  lungs  and  were 
present  mainly  in  the  proximal  tubular 
cells. 

Examination  of  tissue  from  the  thyroid, 
parathyroid,  thymus,  lymph  nodes,  skin,  in- 
testinal tract,  bone  marrow,  adrenal  glands, 
pancreas  and  spleen  failed  to  reveal  cellu- 
lar inclusion  bodies.  Permission  for  exam- 
ination of  the  central  nervous  system  was 
not  obtained.  The  salivary  glands  were  not 
removed  because  the  nature  of  the  disease 
was  not  suspected  at  the  time  of  autopsy. 
Cultures  for  viruses  were  not  made. 

Comment 
The  most  interesting  feature  of  the  pre- 
sent case  is  that  of  the  severe,  unremitting 
diarrhea.  A  correlation  of  diarrhea  with 
intestinal  involvement  is  difficult,  since 
diarrhea  has  been  reported  both  in  the  ab-  ■ 
sence  and  presence  of  inclusion  bodies'3'. 
In  some  cases,  moreover,  typical  nuclear  in- 


July,   1960 


SALIVARY  GLAND  VIRUS  DISEASE— GILBERT 


272 


»'  •  w5S-*4*J  .•*/■'-■.-  «->-.*. i*ss:v*-,'**v."l**.L  «    ._.*         *  "    •  •  Ti  v 


Fig.  1.  Photomicrograph  of  the  lung  demonstrat- 
ing the  large  intra-alveolar  cells  containing  nuclear 
and  cytoplasmic  inclusion  bodies.  A  marked  inter- 
stitial pneumonia  is  also  present.  (Hematoxylin  and 
Eosin  lOOx) 


Fig.  2.  The  nuclear  and  cytoplasmic  inclusion 
bodies  characteristic  of  the  disease  are  present  in 
the  giant  mononuclear  cells  in  the  alveolus. 
(Hematoxylin  and  Eosin  400x) 


inclusions  were  found  in  the  gastrointestinal 
cosa  when  diarrhea  is  absent.  Though  no 
inclusions  were  found  in  the  gastrointinal 
tract,  the  diarrhea  could  have  been  a  man- 
ifestation  of  the   generalized  disease. 

The  dermatitis  was  thought  to  be  a  sen- 
sitivity reaction  to  either  Dilantin  or  phen- 
obarbital  and  probably  not  related  to  the 
salivary  gland  virus  disease.  In  several  re- 
ported cases,  however,  a  dermatitis  has 
been  described (3>4) ;  and  in  one,  typical  in- 
clusion cells  were  present  in  the  sweat 
glands'5'. 

Evidence  of  renal  impairment  was  sug- 
gested by  an  increasing  blood  urea  nitro- 
gen, and  by  slight  amounts  of  albumin  and 
leukocytes  in  the  urinary  sediment.  There 
was  no  evidence  of  a  bleeding  tendency  ex- 
cept on  the  one  occasion  when  hemorrhagic 
vesicles  developed  over  portions  of  the 
body.  The  hepatomegaly  was  secondary  to 
congestion  and  foci  of  hematopoietic  cells; 
such  foci  are  notable  features  in  many 
cases.  The  splenomegaly  was  secondary  to 
congestion    only.    Organs    other    than    the 


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°  ■  *  r      e ^Lm  a  • 

Fig.  3.  Dilated  proximal  tubule  of  the  kidney 
containing  large  cells  >vith  nuclear  and  cytoplas- 
mic inclusion  bodies.  (Hematoxylin  and  Eosin  600x) 


274 


NORTH  CAROLINA  MEDICAL  JOURNAL 


July,   19G0 


lungs  and  kidneys   did   not  contain   typical 
cellular  inclusion  bodies. 

Correlation  of  the  neurologic  manifesta- 
tions and  the  microcrania  of  the  present 
case  with  those  of  generalized  salivary  gland 
virus  disease  cannot  be  made  since  the  cen- 
tral nervous  system  could  not  be  examined. 
In  patients  with  this  disease,  however,  the 
brain  sometimes  shows  typical  cellular  in- 
clusions and  anomalous  developments,  sug- 
gesting that  the  neurologic  disease  in  this 
case  may  have  been  due  to  a  malformation 
related  to  the  viral  infection.  Crome  and 
France"11  report  one  case  associated  with 
microgyria  and  refer  to  other  documented 
cases  with  microgyria,  hydrocephalus,  peri- 
ventricular calcification,  focal  softening 
and  hemorrhage,  and  other  lesions.  The 
periventricular  calcification  has  important 
diagnostic  implications  and  is  discussed  be- 
low. 

The  factor  or  factors  responsible  for  ac- 
tivation of  the  apparently  latent  infection 
in  this  child  are  not  evident,  as  is  true  in 
most  instances  of  the  post-neonatal  group. 
It  is  possible  that  the  drug  reaction  low- 
ered cellular  resistance  and  allowed  a  dor- 
mant, localized  disease  to  become  dissem- 
inated. It  is  also  possible,  however,  that  all 
signs  and  symptoms  were  related  solely  to 
dissemination  of  the  salivary  gland  virus. 

Diagnosis 

In  most  cases  the  disease  is  rarely  diag- 
nosed during-  life.  Hematologic  studies  are 
nonspecific,  commonly  showing  a  moderate 
lymphocytosis  and  slight  immaturity  of  the 
leukocytes  A  normocytic  anemia  and 
thrombocytopenia  occur  in  many  neonatal 
cases.  With  renal  involvement  there  may  be 
a  rise  in  blood  urea  nitrogen;  albumin  and 
leukocytes  may  be  present  in  the  urine. 
Liver  function  tests  may  detect  parenchym- 
al cell  damage.  All  of  these  abnormalities 
are  nonspecific. 

The  most  specific  means  of  diagnosis  at 
the  present  is  the  demonstration  by  cyto- 
logic examination  of  inclusion-bearing  cells. 
The  typical  cells  may  be  found  in  the  urine, 
bronchial  secretions,  or  gastric  washings. 
The  kidneys  are  commonly  involved  in  both 
the  neonatal  and  post-neonatal  phase,  and 
the  most  rapid,  simplest,  and  cheapest  means 
of  establishing  a  positive  diagnosis  in  these 
age  groups  is  by  cytologic  examination  of 


the  urinary  sediment.  In  some  post-neona- 
tal cases  and  in  adult  cases,  examination  of 
sputum  or  gastric  washings  may  establish 
the  diagnosis,  since  patients  in  these  groups 
frequently  have  pulmonary  involvement. 
Details  of  collection  and  preparation  of 
specimens  are  given  in  the  excellent  review 
by  Nelson  and  Wyatt171.  With  central  nerv- 
ous system  involvement,  these  cytologic 
methods  applied  to  the  cerebrospinal  fluid 
may  establish  a  diagnosis' Sl.  Biopsy  ma- 
terials from  the  liver,  lungs,  and  kidneys 
have  contained  the  typical  inclusion  bear- 
ing cells  in  routine  paraffin  sections. 

Radiologic  diagnosis  is  dependent  on  the 
presence  of  periventricular  calcifications 
which  outline  the  lateral  ventricles'8'.  Re- 
covery of  the  virus  by  cultural  methods  has 
been  successful11",  but  at  present  only  a 
few  centers  have  the  equipment  necessary 
for  this  technique. 

Treatment 

There  is  no  specific  treatment.  Antibio- 
tics, steroids,  gamma  globulins,  and  blood 
have  been  employed,  but,  in  most  cases, 
with  disappointing  results.  It  is  not  known 
whether  gamma  globulins  and  blood  con- 
tain effective  antibodies  to  the  virus,  but 
Rowe  and  others'1"'  demonstrated  comple- 
ment-fixing antibodies  in  53  per  cent  of  un- 
selected  persons  between  18  and  25  years  of 
age  and  in  81  per  cent  of  persons  over  the 
age  of  35  years.  In  a  group  of  newborn  in- 
fants, 71  per  cent  had  antibodies,  whereas 
in  the  age  group  of  6  months  to  2  years 
only  14  per  cent  had  demonstrable  anti- 
bodies. It  has  been  suggested  that  pro- 
longed steroid  and  antibiotic  therapy  may 
further  weaken  the  host's  defense  against 
the  disease. 

Summary 

A  case  of  generalized  salivary  gland 
virus  disease  occurring  in  the  post-neonatal 
period  is  presented.  A  brief  discussion  of 
the  important  features  in  the  neonatal, 
post-neonatal  and  adult  forms  of  the  disease 
is  included.  Recently  developed  means  of 
making  an  antemortem  diagnosis  are  dis- 
cussed. The  value  of  cytologic  examination 
of  urine,  sputum,  or  gastric  washings  in 
making  such  diagnoses  is  emphasized. 

References 

1.     (a>      Symmers,     W.     S.     C:      Generalized     Cytomegalic      In- 
clusion-body    Disease     Associated    ■with     Pneumocystis    Pneu- 


July,  19(30 


SALIVARY  GLAND  VIRUS  DISEASE— GILBERT 


275 


monia  in  Adults,  J.  Clin.  Path.  13:1-21  (Jan.)  1960.  (b) 
Capers,  T.  H.  and  Lee,  D. :  Pulmonary  Cytomegalic  In- 
clusion Disease  in  an  Adult.  Am.  J.  Clin.  Path.  33:238- 
242     (March)     1960. 

Wyatt,  J.  P..  Saxton,  J..  Lee.  R.  S.,  and  Pinkerton,  H.: 
Generalized  Cytomegalic  Inclusion  Disease,  J.  Pe  lint. 
36:271-294     (March)     1950. 

Allen,  J.  H..  and  Riley,  H.  D.,  .lr.:  Generalized  Cyto- 
megalic Inclusion  Disease,  with  Emphasis  on  Roentgen 
Diagnosis,    Radiology    71:287-262     (Aug.)     1958. 

Medearis,  D.  N.,  Jr.:  Cytomegalic  Inclusion  Disease;  An 
Analysis  of  the  Clinical  Features  Based  on  the  Literature 
and  6  Additional  Cases.  Pediatrics  19:467-480  (March) 
1957. 


6.     Worth,    W. 


and    Howard,    H.    L. :    New    Features    of    In- 


clusinn    Disease   of    Infancy.    Am.    J.    Path.    26:17-35     (Jan.) 
1950. 

6.  Crome,  L.  and  France.  N.  E. :  Microgyria  and  Cytomega- 
lic Inclusion  Disease  in  Infancy,  J.  Clin.  Path.  12:427- 
434    (Sept.)     1959. 

7.  Nelson,  J.  E.,  and  Wyatt,  J.  P.:  Salivary  Gland  Virus 
Disease,    Medicine    38:223-241     (Sept.)     1959. 

8.  McElfresh,  A.  E.,  and  Arey,  J.  B.:  Generalized  Cyto- 
megalic Inclusion  Disease,  J.  Pediat.  51:146-156  (Aug.) 
1957. 

9.  Kluge,  R.  Cm  Wicksman,  R.  S.,  and  Weller.  T.  H.:  Cy- 
tomegalic Inclusion  Disease  of  the  Newborn,  Pediatrics 
25:35-39    (Jan.)     1960. 

10.  Rowe,  W.  P.,  and  others:  Cytopathogenic  Agent  Resem- 
bling Human  Salivary  Gland  Virus  Recovered  from  Tissue 
Cultures  on  Human  Adenoids,  Proc.  Soc.  Exper.  Biol. 
&    Med.    92:418-424     (June)     1956. 


Antibiotic  Resistant 
Pulmonary  Staphylococcic  Infections 

Captain  George  L.  Calvy,  MC,  USN* 
Camp  Lejeune 


Staphylococcic  infections  have  been  a 
challenging  problem  for  many  years.  Be- 
cause of  the  wide  distribution  of  staphylo- 
cocci in  the  environment  and  on  human 
body  surfaces,  the  problem  will  probably 
remain  for  a  long  time. 

Impressive  evidence  of  penicillin's  bac- 
tericidal potency  was  available  soon  after 
its  introduction.  Strains  of  bacteria  grad- 
ually emerged,  however,  that  exhibited  re- 
sistance to  this  antibiotic.  This  was  par- 
ticularly evident  in  the  case  of  Staphylococ- 
cus aureus.  Additional  antibacterial  agents 
were  introduced  only  to  lose  much  of  their 
effectiveness  as  increasing  numbers  of  these 
antibiotic-resistant  strains  appeared.  The 
following  outline  lists  known  biologic  char- 
acteristics of  the  staphylococcus  which  help 
explain  its  formidable  nature. 
1.     Toxins  and  Lysins 

a.  Exotoxin  (lethal  toxin;  potent;  when  elab- 
orated in  vivo,  its  lethal  effect  appears  to 
be  delayed  until  a  critical  threshold  dose 
has  accumulated;  associated  with  necrotic 
and  hemolytic  reactions  in  a  majority  of 
toxigenic   strains  of   Staph,  aureus.) 

b.  Enterotoxin  (potent  toxin  acting  primarily 
upon  the  gastrointestinal   tract) 

c.  Dermonecrotic  toxin  (necrotizing  toxin; 
hemolysin  ?  )    alpha,  2 

d.  Hemolysin  (alpha,  beta,  gamma,  delta;  rbc 
lysins) 


Read  before  the  Second  General  Session,  Medical  Society  of 
the  State  of  North   Carolina,    Raleigh,   May    11,    1960. 

*Commanding  Officer,  Naval  Field  Research  Laboratory, 
Camp    Lejeune,    North    Carolina. 


e.  Fibrinolysin  (dissolves  fibrin  clots;  re- 
stricted essentially  to  coagulase-positive 
human   strains) 

f.  Leucocidin    (destroys    leucocytes) 
2.     Enzymes 

a.  Coagulase — regarded  as  the  sine  qua  non 
for  pathogenicity  (coagulates  citrated  or 
oxalated  plasma);  also  neutralizes  the  anti- 
bacterial activity  of  normal  human  serum 
for  staphylococci). 

b.  Hyaluronidase  (attacks  the  mucopolysac- 
charide —  hyaluronic  acid  —  intracellular 
ground    substance;    "spreading    factor") 

c.  Staphylokinase       (plasminogen        activator) 

(fibrinolysin? ) 

d.  Penicillinase.  This  is  a  notorious  substance 
responsible  for  treatment  failures  (inac- 
tivates penicillin) 

e.  Gelatinase 

f.  Proteinase 

g.  Lipase 

Note:  Pathogenic  human  (often  of  hospital  ori- 
gin), coagulase-positive  staphylococci  frequently 
belong  to  general  phage  group  III,  types  80/81. 
These  strains  can  now  be  further  identified  by 
fluorescent   antibody   staining   techniques. 

Hospital  Experience 

An  experience  in  a  large  general  hospital 
points  up  facets  of  the  problem'11.  During 
a  two-year  period  more  than  40  cases  of 
antibiotic-resistant  staphylococcic  pneumon- 
ia, principally  due  to  a  hospital-acquired 
strain,  were  diagnosed  and  treated.  This 
hospital  contained  a  large  segment  of  long- 
term  patients,  and  staphylococcic  pneu- 
monia first  appeared  as   a  complication  of 


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July.   191.0 


pre-existing-  major  diseases  such  as  car- 
cinoma, lymphoma,  and  urologic  disorders. 
In  later  instances,  staphylococcic  infection 
occurred  postoperatively  in  more  newly  ar- 
rived patients,  and  suspicion  was  directed 
toward  staff  personnel,  both  medical  and 
surgical,  as  well  as  nursing  attendants, 
who  might  be  carrying  pathogenic  strains 
and/ or  hidden  lesions  (furuncles,  boils, 
and  so  forth).  Screening  measures  were  in- 
stituted to  identify  these  carriers  and  to 
limit  the  assignment  and  movement  of  such 
personnel.  Finally,  a  sharp  upsurge  in  in- 
cidence of  staphylococcic  infections  oc- 
curred at  the  height  of  the  Asian  influenza 
epidemic  in  the  fall  of  1957.  In  addition  to 
patients  who  acquired  infections  in  hospi- 
tal, 1  medical  officer,  1  nurse  and  5  hospital 
corpsmen  fell  victim  to  staphylococcic 
pneumonia,  emphasizing  the  communicable 
aspects  of  this  disease  problem. 

At  the  beginning  of  the  Asian  influenza 
epidemic,  a  significant  number  of  known 
staphylococcic  infections  was  present  in  the 
hospital. 

Cose  1 

The  urgent  and  widespread  character  of  this 
problem  had  previously  been  recognized  when  one 
of  our  young  staff  hospital  men  was  stricken.  He 
had  suffered  from  a  cold  and  had  resorted  to  self- 
medication  with  several  different  antibiotics  during 
a  three-week  period.  During  this  time  his  fiancee, 
a  hospital  WAVE,  was  hospitalized  for  furuncu- 
losis,  and  he  had  also  attended  a  patient  with  se- 
vere staphylococcic  pneumonia.  Shortly  thereafter 
he  was  admitted  to  the  sick  list  with  pleuritic  pain 
and  signs  of  pneumonia.  A  chest  roentgenogram  on 
the  morning  he  was  admitted  was  interpreted  as  be- 
ing essentially  negative.  By  afternoon  extensive 
infiltration  was  demonstrable  in  the  right  base, 
and  by  the  following  morning  radiographic  find- 
ings revealed  areas  of  consolidation  and  infiltra- 
tion involving  the  entire  right  lung  with  extensive 
involvement  of  the  left  lung.  A  positive  blood  cul- 
ture yielded  coagulase  positive  Staphylococcus 
aureus,  phage  type  52-42B-80,  81,  the  so-called 
"hospital  strain."  Despite  heroic  measures  he  died 
on  the  third  hospital  day. 

This  shocking  case  served  to  provoke  the 
action  outlined  in  table  1. 

The  Pneumonia  Team  consisted  of  four 
medical  officers  who  stood  a  telephone 
watch  and  were  available  as  consultants 
around  the  clock.  Whenever  a  patient  sus- 
pected of  having  pneumonia  was  admitted, 
the  medical  officer  got  in  touch  with  a  mem- 
ber of  the  team  and  discussed  the  general 


Table  1 

Task   Force    Staphylococcus 

January    15,   1957 

I.  Antibiotic    Control    Board — chloramphenicol. 

novobiocin   and   ristocetin   reserved   for   severe 
infection 

II.  Pneumonia   team    (telephone  watch) 
III.     Epidemiology   center 

1.  Epidemiology  officer 

2.  Sanitation  technician 

3.  Bacteriologist 

4.  Representative  from  Medicine,  Surgery, 
Genitourinary,  Laboratory,  and  Nursing 
services. 

problem,  the  bacteriologic  study  of  the  spu- 
tum, and  the  radiologic  changes.  In  this 
manner  a  constantly  high  level  of  clinical 
awareness  of  staphylococcic  pneumonia  was 
maintained.  The  theme  of  this  operation 
was  "do  it  yourself,"  for  the  admitting  doc- 
tor collected  and  examined  the  sputum,  in- 
terpreted his  patient's  x-ray  films,  and 
sought  consultation  at  the  earliest  oppor- 
tunity. Diagnosis  was  made  earlier  and 
treatment  was  standardized ;  tracheostomy 
was  performed  in  21  cases,  both  as  a  pre- 
cautionary and  as  an  emergency  procedure. 
These  factors  are  believed  to  have  contri- 
buted significantly  to  curbing  the  mortal- 
ity rate  in  this  series. 

Hemolytic,  coagulase-positive  staphylo- 
coccic pneumonia  may  present  as  a  ful- 
minant process  terminating  in  death  be- 
fore bacteriologic  proof  can  be  obtained.  In 
such  instances  as  case  1,  large  doses  of  in- 
travenous bactericidal  antibiotics  should  be 
given  while  awaiting  bacteriologic  confir- 
mation. The  following  case  highlights  the 
multiple  complications  and  therapeutic  frus- 
trations that  may  attend  a  fulminant  dis- 
seminated infection. 

Case  2 

A  21  year  old  white  man  was  referred  to  the 
Medical  Service  because  of  pneumonia,  etiology 
undetermined1-1.  The  history  revealed  that  he  had 
sustained  a  fracture  of  the  second  cervical  verte- 
bra in  an  automobile  accident.  Treatment  had  con- 
sisted of  "prophylactic  penicillin  and  streptomy- 
cin" and  tong  traction.  While  he  was  receiving 
these  antibiotics,  a  secondary  infection  of  the 
scalp  became  evident.  Generalized  urticaria  de- 
veloped, and  penicillin  was  stopped.  Two  days 
later  a  fever  of  106  F.  and  a  nonproductive  cough 
developed.  The  patient  was  then  started  on  terra- 
mycin,  500  mg.  given  intravenously  twice  daily, 
with  no  effect.  A  roentgenogram  of  the  chest  re- 
vealed   pneumonia    in    the    right   upper    lobe.    Intra- 


July,   1960 


PULMONARY  STAPH  INFECTIONS— CALVY 


277 


venous  terramycin  was  continued  for  two  days, 
during  which  time  his  condition  deteriorated  rap- 
idly. When  received  on  the  Medical  Service  he  was 
semicomatose    and    cyanotic. 

A  tracheostomy  was  performed  and  the  aspirate 
cultured  out  hemolytic  Staph,  aureus,  coagulase- 
positive.  A  culture  of  the  scalp  infection  and 
blood  cultures  revealed  the  same  organism.  Chlor- 
amphenicol, 500  mg.  given  orally  every  four  hours, 
was  started  (before  the  culture  reports  were  ob- 
tained). During  this  time  his  condition  worsened, 
with  the  rapid  appearance  of  left  ventricular  fail- 
ure and  cyanosis.  Intravenous  sulfadiazine,  3.75 
Gm.  every  12  hours,  was  started;  rapid  digitaliza- 
tion  and  phlebotomy  were  performed,  and  respir- 
atory support  was  maintained  by  a  Drinker  res- 
pirator. During  the  next  three  days  the  temper- 
ature dropped  by  lysis,  and  objective  improvement 
was  evident;  however,  on  the  fourth  day,  semi- 
coma recurred. 

Sensitivity  studies  on  the  material  previously 
obtained  for  culture  revealed  in  vitro  sensitivity 
to  Aureomycin,  bacitracin,  chloramphenicol,  ery- 
thromycin, nitrofurantoin,  neomycin,  tetracycline, 
hydrochloride,  and  novobiocin.  In  vitro  resistance 
was  found  to  dihydrostreptomycin,  penicillin,  poly- 
myxin B,  terramycin,  and  sulfadiazine.  Erythro- 
mycin, 200  mg.  given  every  four  hours  intramus- 
cularly, and  Aureomycin,  500  mg.  every  six  houis 
by  nasogastric  tube,  were  administered,  resulting  in 
a  drop  of  temperature  to  102  to  103  F.,  where  it 
remained.  Under  this  regimen,  however,  the  pneu- 
monic process  extended  to  involve  the  entire  right 
lung  and  the  left  upper  lobe. 

On  the  fifth  day  of  this  phase  of  the  regimen,  the 
patient  had  a  right  spontaneous  pneumothorax, 
with  resulting  pyothorax  and  open  bronchopleural 
fistula.  Subsequent  antibiotics  and  chemical  agents 
consisted  of  combinations  of  novobiocin,  sulfadia- 
zine, erythromycin,  and  streptomycin,  during 
which  time  the  patient  developed  a  persistent 
tachycardia  of  150,  pericardial  friction  rub,  electro- 
cardiographic evidence  of  pericarditis,  fixed  spe- 
cific gravity  of  urine,  and  continuous  albuminuria. 
Fever  continued  between  102  and  104  F.,  and  the 
spleen  became  palpable.  A  full-blown  septicemia 
was  evident  at  this  time. 

All  values  remained  static  until  ristocetin,  1000 
mg.  initially  and  250  mg.  every  six  hours,  was 
started  intravenously,  in  combination  with  the 
previously  mentioned  antibiotics.  Ristocetin  was 
continued  with  a  gradual  tapering  in  dosage  for 
12  days,  at  which  time  fever  dropped  by  lysis. 
Evidence  of  pericarditis  disappeared,  the  spleen 
was  no  longer  palpable,  blood  cultures  became 
negative,  dissemination  of  the  pneumonic  process 
appeared  to  be  arrested,  with  localization  of  em- 
pyema pockets  amenable  to  thoracentesis  and 
closure  of  the  bronchopleural  fistula.  Rapid  sub- 
jective and  objective  improvement  of  the  patient 
ensued.  Intravenous  ristocetin  was  discontinued 
after   12  days,  and  the  patient  was   maintained   on 


oral   novobiocin,  500   mg.   every   six   hours,   for   the 
next  two  months. 

This  case  demonstrates  the  gravity  of  a 
hospital-acquired  staphylococcic  pneumonia 
and  its  complications.  Eighteen  combina- 
tions of  10  different  antibiotics  and  sulfa- 
diazine were  used  with-  no  apparent  re- 
sponse except  for  transient  response  to  sul- 
fadiazine, to  which  resistance  quickly  oc- 
curred. Erythromycin  and  novobiocin  were 
ineffective;  however,  when  ristocetin  was 
added,  clinical  improvement  was  noted. 
This  man  was  discharged  fully  recovered, 
and  is  carrying  on  at  full  activity. 

Radiologic  characteristics 

Early   in   this  experience   it   became   evi- 
dent that  there  were   radiologic   character- 
istics peculiar  to  staphylococcic  pneumonia, 
of  high  reliability  in  leading  to  diagnosis. 
Radiologic    Findings 
Rapid    Progression — in    hours 
I.     Early — small   patches   of  consolidation 
II.     Infiltration    c    circumscribed    translucencies 

III.  Pleural  effusion 

IV.  Typical — pneumatoceles 

V.     Spontaneous   tension   pneumothorax   c   or   s 
empyema 

Analysis  of  antibiotic  sensitivities  re- 
vealed most  of  the  encountered  organisms 
in  our  series  to  be  resistant  to  the  sulfona- 
mides, tetracyclines,  streptomycin,  and  pen- 
icillin. 

Erythromycin,  which  enjoyed  great  pop- 
ularity in  the  surrounding  community, 
was  ineffective  in  dealing  with  our  severe 
staphylococcic  infections.  The  best  thera- 
peutic results  were  obtained  with  chloram- 
phenicol and  intravenously  administered 
ristocetin.  Vigorous  supportive  therapy  in- 
cluded tracheostomy.  Gamma  globulin  was 
administered  to  16  patients  as  adjunctive 
therapy. 

An  excellent  report  by  Ede,  Davis,  and 
Holmes  emphasized  early  surgical  therapy 
for  complications'"''.  Pulmonary  complica- 
tions encountered  in  our  experience  were 
pneumothorax,  empyema,  lung  abscess,  and 
tension  cysts.  Only  2  patients  had  signifi- 
cant respiratory  disability  after  recovery. 

Comment 

A  recent  editorial  in  the  Neiv  England 
Journal  of  Medicine  pointed  out  the  critical 
role  that  combinations  of  antibiotics  may 
have  played  in  bringing  about  the  present 
state  of  affairs'41.  The  most  popular  and  at 
the  same  time  most  dangerous  of  the  anti- 


278 


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July.   1960 


biotic  combinations  is  that  of  penicillin  and 
streptomycin,  employed  to  treat  many  cases 
when  streptomycin  is  almost  always  redun- 
dant. Unfortunately,  it  also  is  used  for  the 
prophylaxis  of  infections  which  it  rarely 
prevents.  Instead,  it  has  contributed  to  the 
occurrence  and  increased  severity  of  anti- 
biotic-resistant infections  and  serious  toxic 
effects.  A  large  number  of  new  combina- 
tions has  been  introduced.  Since  none  of  the 
combinations  has  clearly  shown  any  thera- 
peutic advantage  over  the  proper  use  of  the 
more  effective  component  alone,  the  patient 
is  unnecessarily  placed  in  "double  jeopar- 
dy"— of  toxic  reactions  and  of  acquiring 
sensitization  to  both  agents. 

Berntsen  and  McDermott'""  observed 
that  the  carrier  rate  among  hospitalized 
patients  receiving  tetracyclines  increased 
nearly  threefold  over  the  rate  among  hos- 
pitalized patients  receiving  no  antibiotics. 
In  addition,  new  strains  were  substituted 
for  old  among  antibiotic  treated  patients  at 
twice  the  rate  observed  in  untreated  pa- 
tients. 

On  the  basis  of  substantial  evidence  sug- 
gesting that  multiple-resistant  strains  of 
Staph,  aureus,  hospital  variety,  are  of  en- 
hanced virulence,  Barber  and  her  colleagues 
at  Hammersmith  Hospital  in  London  made 
a  vigorous  attempt  to  cut  down  the  inci- 
dence of  infection  by  these  organisms16'. 
This  effort  was  combined  with  strict  appli- 
cation of  various  anti-cross-infection  mea- 
sures that  had  been  previously  introduced, 
and  featured :  ( 1 )  marked  restriction  of 
the  use  of  all  antibiotics  for  prophylactic 
purposes;  (2)  strict  limitation  of  the  use 
of  penicillin;  (3)  the  general  employment 
of  double  chemotherapy,  each  drug  being 
used  in  full  doses  and  only  for  definite  in- 
dications. Under  this  policy  a  significant 
reduction  of  antibiotic-resistant  infections 
occurred  and  concomitantly  the  number  of 
infections  sensitive  to  penicillin  rose  sharp- 
ly. 

It  may  be  pointed  out  that  agents  like 
Kanamycin,  vancomycin  and  ristocetin 
have  had  little  tendency  to  produce  resist- 


ance. Such  resistance  is  difficult  to  produce 
in  vitro.  These  antibiotics  are  given  intra- 
venously, a  limiting  factor  in  their  whole- 
sale use. 

Co)iclusion 

In  general,  when  dealing  with  severe 
staphylococcic  infections,  a  focus  on  target 
with  a  narrow  spectrum  antibiotic  may 
bring  best  results.  Success  with  ristocetin 
and  vancomycin  has  been  attributed  to  this 
factor. 

Awareness  of  the  manifestations  and 
gravity  of  staphylococcic  pneumonia,  with 
attention  to  early  diagnosis  and  decisive 
therapy,  both  medical  and  surgical,  is  to  be 
emphasized  as  essential  for  the  successful 
management  of  this  disease. 

Measures  to  lessen  the  incidence  of  staph- 
ylococcic infections  have  been  effective 
when  they  have  emphasized  a  return  to 
principles  of  rigid  asepsis,  isolation  of  in- 
fected patients  and  judicious  control  and 
use  of  antibacterial  agents.  Recognition  of 
the  fact  that  the  use  of  steroids  and  anti-  I 
biotics  may  actually  encourage  invasion  by 
staphylococci  is  essential.  Observance  of 
the  foregoing  measures  may  then  go  far 
toward  suppressing,  if  not  eradicating, 
these  infections. 

References 

1.  Calvy,    G.    L.:     Stalking    the    Staphylococcus:    New    England  H 
J.    Med.    259:532-534     ( Sept.  I      11)     1958. 

2.  Schumacher.  L.  R..  Coates.  J.  R.,  Sowell,  R.  C.  and 
Calvy,  G.  L.:  Staphylococcal  Pneumonia:  A  Clinical 
Evaluation   of  40    Cases.    Clin.    Research    7:267    (April)    1959. 

3.  Ede.  S..  Davis.  G.  M..  and  Holmes.  F.  H.:  Staphylococcic 
Pneumonia.    J.A.M.A.    170:638-643     lJune    6)     1969. 

4.  Editorial:  Antibiotics  in  Fixed  Combinations.  New  Eng- 
land   J.    Med.    262:255-256     I  Feb.    4  1     1960. 

5.  Berntsen,  C  A.,  and  McDermott.  W.:  Increased  Trans- 
missibility  of  Staphylococci  to  Patients  Receiving  an 
Antimicrobial  Drue.  New  England  J.  Med.  262:637-642 
(March   31)     1960. 

6.  Barber,  M..  and  others:  Reversal  of  Antibiotic  Resistance 
in  Hospital  Staphylococcal  Infections,  Brit.  M.  J.  1:11-17 
(Jan.)     1960. 


July,   1960 


279 


Some  Facts  About  Nursing  in  North  Carolina 


Vivian  M.  Culver,  R.N. 
Raleigh 


May  I  thank  the  program  committee  for 
the  invitation  to  appear  before  this  assem- 
bly today.  I  consider  it  a  real  privilege  and 
an  opportunity  to  share  with  you  some  in- 
formation regarding  nursing  and  nursing 
education  in  this  state. 

What  I  have  to  say  about  North  Caro- 
lina's needs  in  nursing  is  not  unique  to  this 
state,  but  this  fact  does  not  make  our  needs 
any  more  palatable.  And  what  I  have  to  say 
in  relation  to  shortages  of  prepared  people 
is  not  peculiar  to  nursing  alone.  We  are 
experiencing  a  real  lag  in  the  preparation 
and  retention  of  members  in  your  group,  in 
my  group,  and  in  other  paramedical  groups 
as  well.  You  are  as  aware  of  these  facts  as 
I. 

In  looking  closely  at  nursing  in  North 
Carolina,  I  could  quote  all  types  of  figures 
for  you.  But  the  fact  remains  that  we  are 
short  of  two  things — nurses  and  nursing. 

The  Shortage  of  Nurses 

Why  are  we  short  of  nurses?  Here  are 
five  principal  reasons  for  this  situation. 

1.  We  do  not  recruit  enough  capable 
young  women — and  men,  too — into  this 
field.  Other  areas  of  endeavor  are  earnestly 
competing  for  high  school  graduates. 

2.  Out  of  the  number  we  do  recruit,  the 
quality  of  the  candidates  yields  about  a  35 
to  40  per  cent  drop-out — not  in  all  cases  for 
scholastic  reasons,  but  in  the  majority.  Too 
many  students  can't  read,  write,  and  think 
productively.  The  course  in  nursing  is 
rugged.  And  high  school  has  never  given 
them  so  much  to  do  in  so  short  a  time. 

3.  Then  after  completing  the  course,  any- 
where from  25  to  35  per  cent  fail  one  or 
more  of  the  five  subjects  in  the  licensure 
examination. 

4.  Then  after  licensure  we  are  constantly 
losing  from  two  to  three  nurses  to  other 
states  for  every  nurse  who  come  here  to 
work. 

5.  And  finally,  no  small  factor  in  this 
problem  is  the  number  of  nurses  who  are 
inactive  in  the  profession.   After  a  number 

Read  before  the  Second  General  Session,  Medical  Society 
of  the  State  of  North   Carolina,    Raleigh,    May    11,    1960. 

•Executive  Secretary,  North  Carolina  Board  of  Nurse  Regis- 
tration  and   Nurse  Education. 


of  child-rearing  years  a  large  percentage 
come  back.  But  presently  there  are  over 
5,000  inactive  nurses  in  North  Carolina. 

I  have  enumerated  five  serious  problems 
in  relation  to  the  short  supply  of  nurses. 
There  are  others  quite  familiar  to  all  of  us. 

The  Shortage  of  Nursing 

Next,  let's  look  at  the  shortage  of  nurs- 
ing. Quite  naturally  a  limited  number  of 
nurses  yields  less  nursing.  But  that  isn't 
the  only  limiting  factor. 

Nursing  is  perhaps  best  described  as  the 
giving  of  direct  assistance  to  a  person,  as 
required,  because  of  the  person's  specific  in- 
ability to  care  for  himself  for  reasons  of 
health11'.  Self-care  means  the  care  which 
all  persons  require  each  day,  and  you  well 
know  what  modifications  are  necessary  dur- 
ing illness. 

Added  responsibilities 

Our  horizons  in  health  care  and  medical 
management  have  expanded  more  in  the 
last  25  to  30  years  than  in  all  previous  his- 
tory combined.  This  lays  tremendous  re- 
sponsibility on  your  shoulders,  not  only  in 
cure  but  in  prevention  and  rehabilitation  as 
well.  The  new  techniques,  methods,  equip- 
ment, drugs,  and  treatments  for  that  30- 
year  period  would  defy  enumeration  by 
anyone  in  this  room  today.  You  have  asked 
my  group  to  help  carry  some  parts  of  your 
expanding  responsibilities.  We  have  tried — 
we  are  trying.  Every  task  that  you  no 
longer  have  the  time  to  do  or  that  you  feel 
is  safe  for  one  with  less  depth  of  medical 
understanding  you  quite  naturally  ask  the 
nurse  to  do.  Just  two  examples — very  ele- 
mentary, yet  significant:  Within  60  years 
the  thermometer  has  moved  from  the  red 
plush  box  in  your  bag  to  every  home  and 
hospital.  And  in  the  last  30  years  the 
sphygmomanometer  has  come  to  be  used 
even  by  the  practical  nurse. 

Today  we  are  struggling  with  the  task 
of  starting  intravenous  fluids — and  trying 
to  determine  what  safe  steps  can  be  taken 
to  ensure  better  care  of  the  "about  to  de- 
liver" mother — among  a  host  of  other  shift- 
ing responsibilities. 


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NORTH   CAROLINA   MEDICAL  JOURNAL 


July,   I960 


Why  do  I  mention  shifting  of  some  re- 
sponsibilities? First,  because  it  is  a  natural 
development  to  a  point;  and  next,  because 
the  greater  the  demands  on  the  nurse  to 
support  the  doctor  in  his  plan  of  medical 
management,  the  less  time  she  has  to  meet 
the  needs  of  the  patient  which  have  no 
doctor's  orders  written  for  them. 

Complexity  of  organization 

Another  factor  in  the  shortage  of  nurs- 
ing is  the  highly  complex  organization  of 
today's  hospitals.  Much  nursing  time  is 
consumed  in  the  mechanics  of  this  organ- 
ized structure.  Some  say  it  is  so  highly 
structured  that  it  is  impersonal — and  this 
fact  is  poorly  understood  by  a  sophisticated 
society. 

What  happens  to  the  person — the  nurse 
who  by  the  very  elements  of  her  employ- 
ment no  longer  has  time  to  assist  the  pa- 
tient? In  due  time  she  is  apt  to  be  satisfied 
in  managing,  scheduling,  ordering,  and  do- 
ing the  highly  technical  things  falling  to 
her  professional  lot.  If  not,  she  is  frus- 
trated, resigns,  and  tries  to  find  some  place 
where  she  can  get  back  to  the  patient's  side. 
Then  she  is  accused  by  management  of  not 
wanting  to  take  responsibility.  I  ask  you — 
responsibility  for  what?  The  patient,  yes, 
but  management  and  direction  of  others, 
no.  Many  nurses  do  not  want  to  be  man- 
agers of  nurses;  they  want  to  take  care  of 
patients.  Our  present  structure  inhibits  this 
desire. 

No  one  factor  is  responsible  for  the 
shortage  of  nursing,  as  you  can  see.  Many 
things  are  at  work  to  bankrupt  professional- 
ly the  bedside  nurse  today.  If  there  ever 
was  a  time  when  hospital  administrators, 
doctors  and  nurses  needed  to  look  critically 
at  how  patients  are  getting  hospital,  med- 
ical, and  nursing  care,  it  was  yesterday. 
This  joint  action  is  long  overdue. 

Inadequacies  in  Nursing  Education 

Nursing  education  in  North  Carolina  is 
almost  low  man  on  the  totem  pole  in  this 
country.  We  have  schools — we're  eighth  in 
the  country  in  number.  We  have  students — 
we're  thirteenth  in  the  country  with  them. 
T}|it  Ayppn  we  put  our  graduates  against 
graduates  from  other  states  on  our  licen- 
sing  examination,  we  are  well  tnwarH  t-Tjp 
bcfttenrr^l  have  sonle1  -oplllloiis"  as  to  why 
this  is  happening — some  based  upon  fact 
1  and  others  upon  feeling.  Many  of  you  have 


opinions  too — likewise  based  upon  fact  and 
feeling. 

Quality  of  teaching 

One  opinion  I  have  is  that  the  quality  of 
teaching  is  below  par.  Why  do  I  think  so? 
Because  31  per  cent  of  our  teachers  are  not 
trained  beyond  their  three-year  diploma 
programs.  They  are  not  prepared  as  teach- 
ers. Teaching  is  itself  a  specialized  art. 

I  am  not  talking  here  about  those  few 
unique  individuals  among  the  31  per  cent 
who  are  naturals  in  the  teaching  role.  I  am 
concerned  that  too  many  of  the  remaining 
souls  in  that  group  are  not  giving  the  stu- 
dent a  fair  chance  to  learn  nursing.  It  could 
and  should  be  said  that  merely  having  a  de- 
gree does  not  ensure  that  fair  chance  to 
learn,  either.  But  if  additional  preparation 
means  anything,  it  should  provide  a 
broader,  deeper  insight  into  the  content  to 
be  taught,  and  effective  ways  to  get  it 
across. 

Along  with  our  lag  in  preparation  for 
teaching,  we  are  short  in  numbers  of 
teachers.  As  of  March  30,  1960,  14.6  per 
cent  of  the  teaching  positions  in  diploma 
schools  were  unfilled.  And  the  prospect  is 
worse  for  fall.  We  do  not  have  the  teachers. 
These  things  I  know  to  be  facts. 

Content  of  teaching 

Now  I  have  a  feeling  that  part  of  our 
difficulty  in  our  programs  is  what  I  call 
curriculum  obesity  and  patient-practice 
starvation.  When  people  in  charge  of 
schools  do  not  know  how  to  design  and  im- 
plement a  curriculum,  there  is  a  great  urge 
to  add  first  one  course  and  then  another, 
thus  thinking  that  they  are  keeping  the  pro- 
gram up  to  date.  This  is  where  the  obesity 
sets  in,  and  for  every  unneeded  hour  added 
to  the  classroom  schedule  we  deny  the  stu- 
dent the  opportunity  of  that  hour  to  put  into 
action  some  of  her  learning.  What  has  hap- 
pened is  that  there  is  less  and  less  time  to 
teach  and  learn  the  art  of  meeting  the  needs 
of  patients. 

In  this  process  of  addition  we  have  not 
carefully  scrutinized  what  we  teach,  nor 
have  we  done  a  good  job  of  distilling  those 
elements  which  have  always  been  and  will 
continue  to  be  the  essence  of  effective  nurs- 
ing. We  are  trying — but  it  takes  a  qualified 
person  to  lead  the  faculty  to  such  action. 
When  such  a  person  is  lacking,  a  school 
rocks  along,  not  knowing  how  to  tighten  up 


I 


I 


July,   1960 


NURSING  IN  NORTH  CAROLINA— CULVER 


281 


the  curriculum  and  put  back  into  nursing 
those  elements  that  have  been  crowded  out. 
iWise  choices  must  be  made  in  selecting  con- 
tent. If  the  essence  of  nursing  has  been  re- 
placed with  what  appears  to  be  more  im- 
portant content,  the  faculty  has  some  im- 
portant decisions  to  make. 

We  need  to  help  the  student  to  learn  to 
think  through  nursing  situations— to  draw 
I  on  her  knowledge  and  develop  judgment  in 
carrying  out  her  designated  ministrations. 
Too  often  we  fill  the  student  with  facts  and 
then  siphon  them  off  in  a  test.  Until  these 
facts  are  put  to  practical  use — until  they 
are  understood  and  translated  into  nursing 
care  action — are  they  learned? 

I  honestly  believe  that  this  is  one  impor- 
tant and  significant  reason  why  we  have  so 
many  State  Board  failures.  The  questions 
are  just  not  that  difficult.  They  are  thought- 
provoking — yes.  They  are  situational — yes ; 
they  draw  upon  knowledge — yes;  and  they 
ask  for  designated  action,  judgment,  read- 
ing ability,  familiarity  with  vocabulary, 
and  reasoning  ability. 

We  have  recently  visited  a  state  in  the 
deep  South  to  try  to  determine  why  their 
graduates  pass  State  Boards  and  ours  fare 
so  poorly.  One  finding  was  that  every  school 
has  some  prepared  faculty.  They  make  it 
their  business  to  teach  less  medicine  and 
more  nursing.  They  locus  on  trie  p'allfelll  111 
their  teaching  and  in  the  student's  practice. 
'  This  we  are  beginning  to  do,  too,  but  we  are 
having  a  hard  time  shaking  loose  from  the 
idea  that  the  focus  should  not  be  on  the  dis- 
ease but  on  how  to  nurse  the  patient  who 
has  specific  needs  because  he  has  a  certain 
disease  or  deficiency. 

Need  for  a  Joint  Approach 

I  will  never  have  a  better  opportunity  to 
thank  you  ladies  and  gentlemen  for  your 
continuing  efforts  and  interest  in  nursing 
education  in  this  state.  We  appreciate  and 


need  your  contributions.  We  also  need  your 
continued  understanding  to  help  us  with 
our  boot  strap  operation. 

I  would  like  to  see  North  Carolina  lead 
the  nation  in  a  joint  study  of  this  serious 
problem  of  shortage  of  nurses  and  nursing. 
I  would  like  to  see  medicine,  hospital  ad- 
ministration, and  nursing  attack  the  prob- 
lem together.  In  some  states  the  medical 
group  appoints  a  committee,  makes  a  study, 
and  comes  out  with  a  report.  Hospital  ad- 
ministration agonizes  over  it  and  from  time 
to  time  tries  to  solve  the  whole  thing  at  a 
convention.  This  problem  is  much  too  com- 
plex for  such  atomistic  attacks.  It  is  serious 
enough  to  tax  the  combined  effort  of  all 
concerned.  North  Carolina  could  make  such 
an  approach,  and  by  so  doing  could  set  an 
example  of  the  leadership  so  woefully 
needed  today  in  arriving  at  solutions. 

We  had  some  joint  action  in  North  Car- 
olina during  the  Good  Health  movement. 
The  nation  watched  North  Carolina  at  that 
time  with  great  interest.  A  report  was  pub- 
lished in  1950  concerning  our  needs  in 
nursing.  We  have  not  done  much  during 
this  decade  to  come  really  to  grips  with 
those  recommendations  or  to  know  whether 
they  were  realistic  or  attainable.  Many  of 
the  recommendations  are  still  unmet — and, 
I  might  say,  unknown  and  forgotten. 

We  must  come  to  grips  with  what  is 
realistic  for  us  to  do  in  North  Carolina  and 
what  is  unattainable.  To  do  this  we  need 
facts — more  facts  with  less  emotionalism 
and  I  might  even  add  less  provincialism. 
This  is  a  serious  challenge.  Until  we  meet 
it,  hospital  administrators,  doctors,  and 
nurses  will  continue  to  talk  about  this  prob- 
lem in  misty  generalities. 

Reference 

1.  Orem,  D.  E. :  Guides  for  Developing  Curricula  for  the 
Education  of  Practical  Nurses.  Washington.  D.C.,  U.  S. 
Department    of    Health.    Education     and     Welfare,     1959. 


...  it  is  necessary  that  both  in  schools  and  in  universities  we  should 
rediscover  the  part  played  by  leisure  in  education.  There  is  a  danger  that 
we  may  so  fill  our  pupils'  lives,  not  only  with  specialist  studies,  not  only 
with  the  process  of  overfrequent  examining,  but  with  general  education 
and  social  activities  as  well,  that  they  may  never  have  time  to  read  or 
talk  or  even  simply  to  think  what  it  is  all  about. — Sir  Eric  James,  Brit. 
M.J.  2:576   (Sept.  6)   1958. 


L'SL' 


NORTH  CAROLINA   MEDICAL  JOURNAL 


July,   1960 


A  Rural  Home  Care  Program 

O.  David  Garvin,  M.D.,  M.P.H. 
Chapel  Hill 


To  tell  you  about  the  Rural  Home  Care 
Program  now  being  carried  on  in  Person 
County,  North  Carolina,  I  must  tell  you  a 
little  about  the  county.  Person  County  is 
one  of  five  counties  making  up  the  district 
of  which  I  am  director.  It  is  located  in  the 
north  central  portion  of  the  state  and 
covers  an  area  of  20  miles  square,  with  one 
town,  Roxboro — population  5,000.  The  total 
population  of  the  county  is  25,000  of  whom 
about  40  per  cent  is  non-white.  It  is  one  of 
the  few  counties  that  experienced  a  popu- 
lation loss  between  1940  and  1950.  This 
loss  was  attributed  to  the  migration  of  able- 
bodied  persons  in  search  of  work.  These 
migrants  leave  their  children  behind  in  the 
care  of  grandparents,  creating  many  prob- 
lems and  difficult  financial  situations. 

Person  County  is  primarily  rural,  deriv- 
ing its  income  chiefly  from  farm  products 
(tobacco),  with  a  few  small  manufacturing 
companies  located  around  the  town  of  Rox- 
boro. 

Person  County  has  11  practicing  physi- 
cians— one  retired  for  all  practical  pur- 
poses, two  surgeons,  one  internist,  and 
seven  general  practitioners,  two  of  these 
being  over  70  years  of  age.  There  is  a  good 
60-bed  general  hospital  (constructed  with 
Hill-Burton  funds).  The  Health  Depart- 
ment is  housed  in  a  new  building.  Within 
50  miles  of  Roxboro  are  four  large  medical 
centers.  The  working  relationship  within 
the  county  has  been  cooperative  and  har- 
monious. 

Tuberculosis  Program  Paves  the  Way 
When  I  came  to  Person  County  in  1944,  I 
found  a  minimal  tuberculosis  program  di- 
rected toward  the  far  advanced  cases  be- 
cause of  limited  facilities  and  personnel.  At 
that  time,  tuberculosis  and  venereal  disease 
were  the  most  pressing  health  problems  in 
the  county.  As  a  result  of  improved  medica- 
tion, refined  diagnosis  and  techniques  in 
health  education,  the  venereal  disease  prob- 
lem has  been  brought  under  control.  We 
have  worked  just  as  diligently  on  our  tu- 
berculosis problem,  with  the  result  that 
our  death  rate  from  tuberculosis  is  virtual- 


Read    before    the    Regional    Conference    on    Aging,    Atlanta, 
Georgia,    March    7,    I960. 


ly  nil,  while  our  case  rate  increases  and  our 
total  number  of  cases  under  supervision 
multiplies.  Last  year  our  county  had  one  of 
the  highest  case  rates  in  the  state. 

I  emphasize  the  role  of  tuberculosis  in 
our  set-up  because  of  its  direct  bearing  on 
the  present  Home  Care  Program.  Fifteen 
years  ago  when  it  became  evident  that 
many  of  our  tuberculous  patients  were  dy- 
ing at  home  while  awaiting  sanatorium  ad- 
mission, a  program  of  home  care  was  a 
pressing  necessity.  At  the  suggestion  of  the 
County  Medical  Society,  the  County  Board 
of  Commissioners  provided  extra  funds  for 
hospitalization,  employment  of  additional 
public  health  nurses,  and  purchase  of  equip- 
ment for  the  home  care  of  the  tuberculous. 
In  this  program,  the  Health  Department 
played  the  major  role  by  furnishing  the 
x-ray  facilities  for  screening,  diagnosis, 
and  follow-up,  and  I  provided  medical  care 
within  the  home  for  patients  who  were 
under  the  supervision  of  the  local  doctors. 

This  program  was  agreed  on  and  devel- 
oped jointly  by  the  Health  Department, 
Medical  Society,  County  Board  of  Commis- 
sioners, and  other  agencies  both  voluntary 
and  official.  At  this  particular  time  no 
young  doctors  were  practicing  within  the 
county,  and  it  was  the  wish  of  the  local 
medical  society  that  I  provide  the  tubercu- 
losis treatment  while  they  supervised  the 
case  and  treated  any  complications  or  acute 
illnesses  that  occured.  Later,  the  County 
Board  of  Commissioners  provided  funds 
for  drug  therapy  for  tuberculosis  cases. 

As  a  result  of  the  successful  handling  of 
the  tuberculosis  problem  in  the  county  and 
the  harmonious  cooperation  of  everyone 
concerned,  it  was  no  problem  to  secure  sup- 
port for  the  expanded  Home  Care  Program. 
In  addition  to  our  Tuberculosis  Program, 
we  were  confronted  with  an  aging  popula- 
tion afflicted  with  so-called  "chronic  dis- 
ease." Throughout  all  these  years  of  work, 
publicity  was  given  the  work  being  done 
and  the  needs  existing  within  the  county. 
All  media  were  used  to  inform  the  county 
officials  and  the  public  of  the  needs  of  the 
county. 


July,   1960 


RURAL  HOME  CARE— GARVIN 


283 


Project  Proposal  Approved 

Several  years  ago  the  local,  State  and 
American  Medical  Associations,  the  local, 
State  and  National  Public  Health  agencies, 
and  officials  at  all  levels  of  government  be- 
gan to  realize  that  a  program  for  Home 
Care  should  be  developed,  and  that  it 
should  not  be  restricted  to  urban  areas  but 
made  available  to  all  people.  Until  we  un- 
dertook to  provide  home  care  in  this  rural 
area,  no  similar  project  had  been  developed. 
When  it  was  suggested  that  support  from 
official  agencies,  the  Public  Health  Service, 
and  the  State  Board  of  Health  could  be 
secured  if  the  county  would  provide  some 
funds  for  matching  purposes,  it  was  not 
difficult  to  secure  the  local  support  needed. 

In  cooperation  with  the  Person  County 
Medical  Society,  the  State  Board  of  Health, 
and  the  U.  S.  Public  Health  Service,  a  pro- 
ject proposal  was  prepared  and  submitted. 
After  the  State  Board  of  Health  and  the 
Public  Health  Service  gave  tentative  ap- 
proval, the  County  Commissioners  appro- 
priated a  sum  of  money  for  matching  pur- 
poses. Final  approval  was  given  the  project 
and  the  following  personnel  were  author- 
ized :  a  medical  social  worker,  physical 
therapist,  two  public  nurses,  and  one  clerk. 
Also,  funds  for  contractural  purposes  were 
made  available. 

The  tentative  project  proposal  was  not 
prepared  or  submitted  until  it  had  been 
discussed  in  detail  with  the  local  medical 
society,  and  a  set  of  policy  and  procedure 
statements  relating  to  every  phase  of  the 
anticipated  program  had  been  developed. 
The  local  society  agreed,  without  a  single 
dissenting  voice,  to  provide  medical  care 
and  supervision  for  all  persons  residing 
within  the  county  who  were  referred  to  and 
carried  by  the  project.  The  purpose  or  ob- 
jectives are  "To  show  how  National,  State 
and  Local  agencies,  both  official  and  non- 
official,  can  coordinate  their  efforts  in  a 
program  for  Home  Care  and  restoration  of 
the  chronically  ill  in  a  rural  area  and  to  de- 
termine what  personnel  and  funds  are  ne- 
cessary to  provide  for  services  aimed  at 
self  care  or  self  support  by  the  patients." 

At  this  time,  it  was  agreed  that  the 
doctor-patient  relationship  would  remain  in 
effect  at  all  times ;  that  the  project  would 
not  accept  patients  referred  by  anyone 
other  than  the  physician.  The  physician 
would  continue  to  direct  the  care  of  the  pa- 


tient at  all  times,  the  Health  Department 
would  provide  services  available  through 
the  staff,  and  no  fee  would  be  charged  for 
services  rendered  by  the  staff  of  the  Health 
Department.  After  the  endorsement  by  the 
local  medical  society,  the  project  proposal 
was  submitted  through  official  channels. 
Operation  began  officially  when  the  phy- 
sical therapist  reported  for  duty.  The  pro- 
ject is  now  operating  with  a  full  staff  of 
qualified  workers. 

Home-Care  Integrated  into  Total 
Health  Program 

We  have  endeavored  to  integrate  this 
program  into  the  over-all  program  of  the 
Health  Department  and  of  the  many  other 
agencies  providing  health  services  in  the 
community.  The  services  available  through 
the  project  are  nursing,  physical  therapy, 
social  service,  occupational  therapy,  nutri- 
tional counseling,  medicine  and  sick  room 
supplies,  orthopedic  equipment,  and  health 
education.  Every  other  community  resource 
is  brought  to  bear  upon  the  patient's  illness 
through  the  coordination  of  the  Health  De- 
partment. Lay  committees  organized  dur- 
ing the  planning  stage  are  Health  Educa- 
tion, Procurement  and  Supply,  Vocational 
Rehabilitation,  Social  Service,  and  Chap- 
lain and  Recreation.  In  addition,  there  is 
an  advisory  and  technical  committee  made 
up  of  representatives  from  local  and  State 
medical  societies,  local  and  state  welfare 
associations,  State  Nurses'  Association, 
State  Board  of  Health,  and  the  University 
of  North  Carolina  School  of  Public  Health. 

All  benefits  to  the  individual  patient  in 
the  program  are  the  result  of  a  concerted 
"team  effort."  The  Health  Department 
team  teaches  and  provides  services  as 
ordered  by  the  attending  physician.  The 
patient  and  his  family  are  taught  the  pro- 
per care  of  the  patient  through  the  actual 
services  of  the  physical  therapist,  the  Pub- 
lic Health  nurse,  the  medical  social  worker, 
and  the  nutritionist.  Thus  the  private  phy- 
sician and  this  team  work  as  an  effective 
unit  toward  the  achievement  of  maximum 
recovery  and  physical  independence  of  the 
patient. 

I  spent  much  of  the  time  alloted  me  in 
discussing  the  history  of  the  Person  Coun- 
ty Home  Care  Demonstration  Project  and 
the  needs  that  brought  it  into  being.  This 
project  was  a  natural  outgrowth  of  com- 
munity   recognition   and    interest.    In    fact, 


284 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July,   1960 


the  medical  society,  county  officials,  and  the 
public  at  large  have  cooperated  in  a  man- 
ner that  has  been  heartwarming  to  those  of 
us  who  so  often  have  seen  this  segment  of 
our  population  cast  into  the  role  of  the  for- 
gotten man.  This  is  a  type  of  program  that 
can  be  developed  and  operated  in  any  rural 
area  where  there  are  an  informed  public, 
medical  facilities,  and  an  agency  that  can 
serve  as  coordinating  agent. 

I  want  to  restate  the  purpose  of  the  pro- 
ject, "To  demonstrate  how  Federal,  State, 
and  Local  Official  and  non-official  agencies 
in  the  community  as  individuals  and  as  a 
whole  can  coordinate  their  efforts  in  an  or- 
ganized program  for  the  Home  Care  and 
Restoration  of  the  chronically  ill  in  a  rural 
area.  Further,  to  determine  the  number  of 
people  and  the  funds  necessary  to  provide 
restoration  services  which  aim  at  self-care 
and/or  self-support   of  the   patients." 

Aims  and  Achievements 
This  home  care  program  in  Person  Coun- 
ty  has  been   in  operation    since   September 
8,  1958.  We  think  that  the  following  results 
have  been  achieved : 

1.  The  first  rural  Home  Care  Project 
has  been  established. 

2.  The  project  has  been  developed  with- 
out serious  conflicts  of  interest. 

3.  It  has  had  public  acceptance. 

4.  There  has  been  a  gradual  build-up  of 
patients  admitted  to  the  program. 

5.  A  harmonious  working  relationship 
with  the  doctors  has  been  maintained. 

6.  A  physical  therapy  department  has 
been  prepared  and  equipped  at  the 
county  hospital. 

7.  The  community  has  united  to  support 
and  promote  the  project. 

8.  The  project  has  provided  a  health 
education  topic. 

There  have  been  problems  as  may  be  ex- 
pected with  any  new  program;  but  these 
were  chiefly  associated  with  record  devel- 
opment and  recruitment  of  specialized  per- 
sonnel. 

You  might  ask,  "What  are  the  antici- 
pated  results?"   I   will   list  the  major  aims. 

1.  To  provide  information  about  the 
cost  of  home  care  in  a  rural  area. 

2.  To  shorten  the  period  of  hospital 
stay  for  patients  with  long-term  ill- 
ness. 

3.  To  extend  into  the  home  services 
ordinarilv   restricted   to  hospital. 


4.  To  reduce  the  number  of  people  dis- 
abled by  chronic  conditions. 

5.  To  effect  a  reduction  of  cost  to  the 
county  for  hospital  and  welfare  care 
for  persons  with  long-term  illness. 

6.  To  provide  adequate  medical  care  for 
the  people  of  Person  County. 

Analysis  of  Results 

Between  September  8,  1958,  and  Decem- 
ber 31,  1959,  55  patients  had  been  referred. 
Of  these,  54  were  admitted  to  the  program 
and  given  service.  Before  a  person  is  ac- 
cepted several  things  must  be  done: 

1.  The  patient  is  referred  by  a  doctor, 
using  a  form  developed  by  the  team. 

2.  Representatives  of  all  disciplines 
visit  and  evaluate  patient. 

3.  An  admission  conference  is  held  with 
the  following  in  attendance:  the  phy- 
sician in  charge  of  case,  the  medical 
social  worker,  the  physical  therapist, 
a  Public  Health  nurse,  and  other  in- 
terested persons. 

4.  Patient  must  show  potential  for  re- 
storation to  self-help  or  employment. 

Up  to  the  present  time,  13  patients  have 
been  discharged  (by  conference  similar  to 
admission  conferences)  from  the  program, 
with  40  active  at  the  present  time  and  1 
classed  as  inactive.  Of  the  13  discharged, 
2  achieved  maximum  benefits,  6  died,  3 
moved  out  of  the  county,  and  2  were  dis- 
charged for  other  reasons.  Of  the  40  given 
service,  29  were  classed  as  active  in  the 
home,  5  as  active  out-patients,  and  6  as  ad- 
visory in  the  home.  When  the  program  be- 
gan, there  were  3  chronically  ill  persons  in 
the  local  hospital  who  had  been  there  more 
than  a  year.  Today  2  of  these  are  at  home 
and  the  third  has  died.  One  of  the  patients 
that  we  are  caring  for  in  the  home  today 
reportedly  cost  a  hospital  in  a  neighboring 
county  $17,000  before  discharge. 

You  will  recall  that  to  date  6  patients 
have  died.  This  mortality  can  be  explained 
by  the  fact  that  the  median  age  for  patients 
accepted  on  the  program  is  slightly  more 
than  67  years.  Of  the  total  45  given  care 
during  the  past  three  months,  12  were  60 
to  69  years  of  age,  13  were  70  to  79,  and 
4  were  more  than  80. 

Thirty-five  of  the  patients  were  white 
and  10  were  non-white,  eighteen  were  male 
and  27  were  female.  The  socioeconomic 
classification  was  as  follows :  high  bracket, 


July,   1960 


RURAL  HOME  CARE— GARVIN 


285 


6;  middle  bracket,  16;  low  bracket,  10; 
Public  Assistance  recipients,  13.  Please 
note  that  we  do  not  deny  admission  to  any- 
one because  of  financial  status  or  race. 

Of  the  45  patients  handled  during  the 
past  three  months,  primary  diagnoses  were 
as  follows:  cardiovascular  accidents,  15; 
arthritis,  11;  fractures,  9;  neurologic  dis- 
orders, 5 ;  burns,  2 ;  scoliosis,  1 ;  multiple 
sclerosis,  1;  muscular  distrophy,  1.  You 
might  be  surprised  to  learn  that  obesity 
was  listed  as  the  secondary  diagnosis  in  6 
cases ;  arthritis  in  5 ;  high  blood  pressure  in 
5;  diabetes  in  4.  Many  other  conditions 
made  up  the  remainder. 

To  render  the  needed  services  to  these 
patients,  36  admission  conferences,  90  re- 
view conferences,  and  4  discharge  confer- 
ences have  been  held  during  the  past  year, 
for  a  total  of  130.  Visits  made  to  patients 
by  members  of  the  health  department  team 
were  630  by  public  health  nurses,  849  by 
the  physical  therapist,  and  96  by  the  med- 
ical social  worker.  These  figures  may  sound 
small,  until  it  is  remembered  that  we  are 
working  in  a  small  county  with  a  limited 
staff,  limited  financial  resources,  and  that 
we  have  experienced  difficulties  in  securing 
qualified  personnel. 

I  have  said  that  the  project  would  pro- 
vide care  only  for  persons  who  will  benefit 
and  can  be  restored  to  self-care  or  self- 
support.  The  project  itself  does  not  provide 
for  the  admission  of  terminal  care  cases. 
Patients  needing  terminal  care  are  ad- 
mitted to  the  general  public  health  program 
and  are  serviced  by  the  staff  of  the  Health 
Department. 

Conclusioyi 
The  people  of  Person  County  are  proud 
of  the  fact  that  this  is  the  first  project  of 
its  kind  to  be  carried  on  in  a  rural  area  in 
the  United  States.  We  are  determined  to 
make  it  work  and  to  provide  answers  to  the 
questions  posed  by  those  supporting  the 
project.  The  questions  are: 

1.  What  are   the   benefits  derived   from 
such  a  project? 

2.  Are  they  too  expensive? 

3.  How  can  medical  care  of  the  chron- 
ically ill  be  financed  best? 

We  are  convinced  that  the  project  and 
the  Home  Care  Program  provides  aid  and 
assistance  to  the  general  practitioner  or  lo- 
cal practitioner  in  the  care  of  his  patient 
in  the  county  hospital  and  the  home. 


SPECIAL    REPORT 

Report  on  Actions  of  the  House  of  Delegates 

American   Medical   Association 

One  Hundred  Ninth  Annual  Meeting 

June  13-17,  1960 

Miami  Beach 

Health  care  for  the  aged,  pharmaceutical 
issues,  occupational  health  programs,  rela- 
tions with  allied  health  groups,  and  rela- 
tions with  the  National  Foundation  were 
among  the  major  subjects  involved  in  policy 
actions  by  the  House  of  Delegates  at  the 
American  Medical  Association's  One  Hun- 
dred Ninth  annual  meeting  held  June  13-17 
in  Miami  Beach. 

Dr.  Leonard  W.  Larson  of  Bismarck, 
North  Dakota,  former  chairman  of  the 
A.  M.  A.  Board  of  Trustees  and  of  the 
A.  M.  A.  Commission  on  Medical  Care 
Plans,  was  named  president-elect  by  unan- 
imous vote.  Dr.  Larson  will  succeed  Dr.  E. 
Vincent  Askey  of  Los  Angeles  as  president 
at  the  Association's  annual  meeting  in 
June,  1961,  at  New  York  City. 

The  A.  M.  A.  1960  Distinguished  Service 
Award,  one  of  medicine's  highest  honors, 
was  given  to  Dr.  Charles  A.  Doan,  who  will 
retire  next  year  as  dean  of  the  Ohio  State 
University  College  of  Medicine  and  director 
of  the  Health  Center  in  Columbus,  Ohio. 

Total  registration  through  Thursday, 
with  half  a  day  of  the  meeting  still  remain- 
ing, had  reached  19,107,  including  8,706 
physicians. 

Health  Care  For  The  Aged 

After  considering  a  variety  of  reports, 
resolutions  and  comments  on  the  subject  of 
health  care  for  the  aged,  the  House  of  Dele- 
gates adopted  the  following  statement  as 
official  policy  of  the  American  Medical  As- 
sociation : 

Personal  medical  care  is  primarily  the  respon- 
sibility of  the  individual.  When  he  is  unable  to 
provide  this  care  for  himself,  the  responsibility 
should  properly  pass  to  his  family,  the  commun- 
ity, the  county,  the  state,  and  only  when  all 
these  fail,  to  the  federal  government,  and  then 
only  in  conjunction  with  the  other  levels  of  gov- 
ernment, in  the  above  order.  The  determination 
of  medical  need  should  be  made  by  a  physician 
and  the  determinati"^  of  eligibility  should  be 
made  at  the  local  levei   .vi+h  local   administration 


This  report  was  forwarded  to  the  Journal  by  Dr.  Klias 
Faison  of  Charlotte,  Secretary  of  the  North  Carolina  dele- 
gates   to    the   A.M. A. 


286 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July,  196fl 


and  control.  The  principle  of  freedom  of  choice 
should  be  preserved.  The  use  of  tax  funds  under 
the  above  conditions  to  pay  for  such  care, 
whether  through  the  purchase  of  health  insur- 
ance or  by  direct  payment,  provided  local  op- 
tion is  assured,  is  inherent  in  this  concept  and  is 
not  inconsistent  with  previous  actions  of  the 
House  of  Delegates  of  the  American  Medical 
Association. 

The  House  also  urged  the  Board  of 
Trustees  "to  initiate  a  nonpartisan  open 
assembly  to  which  all  interested  represen- 
tative groups  are  invited  for  the  purpose 
of  developing  the  specifics  of  a  sound  ap- 
proach to  the  health  service  and  facilities 
needed  by  the  aged,  and  that  thereafter  the 
American  Medical  Association  present  its 
findings  and  positive  principles  to  the  peo- 
ple." 

In  connection  with  an  educational  pro- 
gram regarding  the  aged,  the  House  de- 
clared that  "the  American  Medical  Associa- 
tion increase  its  educational  program  re- 
garding employment  of  those  over  65,  em- 
phasizing voluntary,  gradual  and  individual 
retirement,  thereby  giving  these  individuals 
not  only  the  right  to  work  but  the  right  to 
live  in  a  free  society  with  dignity  and 
pride." 

Earlier,  at  the  opening  session,  Dr.  Louis 
M.  Orr,  retiring  A.  M.  A.  president,  had 
asked  the  House  to  go  on  record  favoring 
more  jobs  for  the  aged,  voluntary  retire- 
ment and  a  campaign  against  discrimina- 
tion because  of  age,  whether  it  be  40  or  65. 
The  House  also  gave  wholehearted  approv- 
al to  Dr.  Askey's  urging  that  state  medical 
societies  take  an  active  part  in  state  confer- 
ences and  other  planning  activities  preced- 
ing the  January,  1961,  White  House  Con- 
ference on  Aging. 

Pharmaceutical  Issues 

In  the  pharmaceutical  area  the  House 
took  two  actions — one  regarding  mail  order 
drug  houses  and  the  other  involving  the 
development  and  marketing  of  pharma- 
ceutical products. 

The  House  agreed  with  representatives 
of  the  pharmacy  profession  that  the  unor- 
thodox practice  of  mail  order  filling  of  pre- 
scription drugs  is  not  in  the  best  interest  of 
the  patient,  except  where  unavoidable  be- 
cause of  geographic  isolation  of  the  patient. 
The  statement  pointed  out  that  in  this  pro- 
cess the  direct  personal  relationship,  which 
exists    between    the    patient-physician-phar- 


macist at  the  community  level  and  which  is 
essential  to  the  public  health  and  the  wel- 
fare of  patients,  is  lost. 

The  House  also  directed  the  Board  of 
Trustees  to  request  the  Council  on  Drugs 
and  other  appropriate  Association  councils 
and  committees  "to  study  the  pharmaceu- 
tical field  in  its  relationship  to  medicine  and 
the  public,  to  correlate  available  material, 
and  after  consultation  with  the  several 
branches  of  clinical  medicine,  clinical  re- 
search, and  medical  education  and  other  in- 
terested groups  or  agencies,  submit  an  ob- 
jective appraisal  to  the  House  of  Delegates 
in  June,  1961."  The  statement  pointed  out 
that  certain  proposals  have  been  made 
which,  if  carried  out,  might  impair  the 
future  of  pharmaceutical  research  and  de- 
velopment, thus  retarding  the  progress  of 
scientific  therapy.  It  also  said  that  the 
services  of  the  pharmaceutical  industry  are 
so  vital  to  the  public  and  to  the  medical 
profession  that  an  objective  study  should 
be  made. 

Occupational  Health  Programs 

The  House  approved  a  revised  statement 
on  the  "Scope,  Objectives  and  Functions  of 
Occupational  Health  Programs,"  which  was 
originally  adopted  in  June,  1957.  The  new 
statement  contains  no  fundamental  alter- 
ations in  A.  M.  A.  policy  or  ethical  rela- 
tionships, but  it  adds  important  new  ma- 
terial on  the  following  points: 

1.  Greater  emphasis  on  the  preventive 
and  health  maintenance  concepts  of  oc- 
cupational health  programs. 

2.  A  more  positive  statement  of  organ- 
ized medicine's  obligation  to  provide 
leadership  in  improving  occupational 
health  services  by  part-time  physicians 
in  small  industry. 

3.  Increased  emphasis  on  rehabilitation 
of  the  occupationally  ill  and  injured. 

4.  Inclusion  of  the  proper  use  of  immun- 
ization procedures  for  employes,  as  ap- 
proved by  the  House  in  1959. 

5.  A  more  adequate  statement  on  the 
need  for  teamwork  with  lay  industrial 
hygienists  in  tailoring  each  occupa- 
tional health  program  to  the  particular 
employe  group  involved. 

In  approving  the  revised  guides  for  oc- 
cupational health  programs,  the  House  also 
accepted  a  suggestion  that  the  A.  M.  A. 
Council   on   Occupational   Health   undertake 


July,  1960 


ADVERTISEMENTS 


XXXI 


HOSPITAL  SAVING  ASSOCIATION,  CHAPEL  HILL 


in  allergic  and  inflammatory  skin  disorders  (including  psoriasis 


Substantiated  by  published  reports  of  leading  clinicians 


•  effective  control 

of  allergic 

and  inflammatory 

symptoms 


1-3.7,8,13-15.17,18 


minimal  disturbance 

of  the  patient's 
chemical  and  psychic 
balance14-18 


mm 

•mil 
Hi 

m 

s 

l(|.iS 


g 


At  the  recommended  antiallergic  and  anti- 
inflammatory dosage  levels,  ARISTOCORT  means; 

•  freedom  from  salt  and  water  retention 

•  virtual  freedom  from  potassium  depletion 

•  negligible  calcium  depletion 

•  euphoria  and  depression  rare 

•  no  voracious  appetite  —  no  excessive  weight  gain 

•  low  incidence  of  peptic  ulcer 

•  low  incidence  of  osteoporosis  with  compression  fracture 

Precautions:  With  aristocort  all  traditional  precautions  to  corticosteroid  therapy 

should  be  observed.  Dosage  should  always  be  carefully  adjusted  to  the  smallest 

amount  which  will  suppress  symptoms. 

After  patients  have  been  on  steroids  for  prolonged  periods,  discontinuance  must  be 
i  carried  out  gradually  over  a  period  of  as  much  as  several  weeks. 

Supplied:  1  mg.  scored  tablets   (yellow)  ;  2  mg.  scored  tablets   (pink)  ;   4  mg. 

scored  tablets  (white)  ;  16  mg.  scored  tablets  (white). 

Diacetate  Parenteral  (for  intra-articular  and  intrasynovial  injection).  Vials  of 
1 5  cc.  (25  mg./cc). 


References:  1.  Feinberg,  S.  M.J  Feinberg,  A.  R.,  and  Fisherman. 
E.  W.:  J. A.M. A.  167:58  (May  3)  1958.  2.  Epstein.  J.  I.,  and  Sher- 
wood. H. :  Conn.  Med.  22:822  (Dec.)  1958.  3.  Friedlaender.  S..  and 
Friedlaender.   A.   S. :  Antibiotic  Med.  &  Clin.    Ther.  5:315    (May) 

1958.  4.  Segal.  M.  S..  and  Duvenci.  J.:  Bull.  Tufts  N.E.  Medical 
Center  4:71  (April-June)  1958.  5.  Segal.  M.  S. :  Report  to  the 
A.M. A.    Council    on    Drugs.    J.A.M.A.    169:1063     (March    7)     1958. 

6.  Hartung.    E.    F. :    /.    Florida    Acad.    Gen.    Practice    8:18.    1957. 

7.  Rein.  C.  R. ;  Fleischwager.  R.,  and  Rosenthal.  A.  L. :  J.A.M.A. 
165:  1821    (Dec.  7)    1957.  8.  McGavack.  T.  H. :  Clin.  Med.    (June! 

1959.  9.  Freyberg,  R.  H. ;  Berntsen,  C.  A.,  and  Hellman.  L. : 
Arthritis  &  Rheumatism  1:215  (June!  1958.  10.  Hartung.  E.  F. : 
J.A.M.A.  167:973  (June  21)  1958.  11.  Zuckner.  J.;  Ramsey.  R.  H.J 
Caciolo,  C.  and  Gantner.  G.  E. :  Ann.  Rheumat.  Dis.  17:398  (Dec.) 
1958.  12.  Appel,  B. ;  Tye,  M.  J.,  and  Leibsohn,  E.  :  Antibiotic  Med. 
&  Clin.  Ther.  5:716  (Dec.)  1958.  13.  Kalz.  F. :  Canad.  M.A.J. 
79:400  (Sept.)  1958.  14.  Mullins,  J.  F..  and  Wilson,  C.  J.:  Texas  J. 
Med.  54:648  (Sept.)  1958.  15.  Shelley.  W.  B.;  Harun.  J.  S..  and 
Pillsbury,  D.  M. :  J.A.M.A.  167:959  (June  21)  1958.  16.  DuBois. 
E.  L. :  J.A.M.A.  167:1590  (July  26)  1958.  17.  McGavack.  T.  H.; 
Kao.  K.  T.;  Leake,  D.  A.;  Bauer,  H.  G.,  and  Berger.  H.  E.  :  Am. 
J.  M.  Sc.  236:720  (Dec.)  1958.  18.  Council  on  Drugs:  J.A.M.A. 
169:257    (January)    1959. 


lid^u: 


LEDERLE  LABORATORIES,  A  Division  of  AMERICAN  CYANAMID  COMPANY,  Pearl  River,  N.  Y. 


Concerning   Your   Health   and   Your   Income 

A  special  report  to  members  of  the  Medical  Society  of 

the  State  of  North  Carolina 

on.  the  progress  of  the  Society's 

Special  Group  Accident  and  Health  Plan 

in  effect  since  1940 

PROUDLY  WE   REPORT    1959 

AS  OUR  MOST  SUCCESSFUL  YEAR  IN  SERVING  YOUR  SOCIETY. 

During   the   year  we    introduced   a   NEW  and  challenging   form  of  disability  protec- 
tion.  There  has  been  overwhelming   response  on  the  part  of  the  membership. 

Participation   in   this  Group  Plan   continues  to  grow  at  a  fantastic  rate. 

1960 

is  our  20th  year  of  service  to  the  Society.  It  is  our  aim  to  continue  to  lead  the  field  in  pro- 
viding Society  members  with  disability  protection  and  claim  services  as  modern  as  tomor- 
row. 

SPECIAL    FEATURES    ARE: 


1.  Up  to  a  possible  7  years  for  each  sickness  (no  confinement  required). 

2.  Pays  up  to  Lifetime  for  accident. 

3.  New  Maximum   limit  of  $650.00  per  month  income  while  disabled. 

All  new  applicants,  and  those  now  insured,  who  are  under  age  55,  and  in  good 
health,  are  eligible  to  apply  for  the  new  and  extensive  protection  against  sickness  and  ac- 
cident. 

OPTIONAL    HOSPITAL   COVERAGE:      Members  under  age  60  in  good  health  may  apply  for 
$20.00  daily  hospital   benefit — Premium  $20.00  semi-annually. 

Write,   or  call    us  collect  (Durham  2-5497)  for  assistance  or  information. 

BENEFITS  AND   RATES  AVAILABLE  UNDER   NEW   PLAN 

COST   UNTIL   AGE   35        COST    FOR   AGES   35   TO 
Accidental    Death  *  Dismemberment 

Coverage  Loss    of    Sight,    Speech 

or    Hearing 

5,000  5,000  to  10,000 

5,000  7,500  to  15,000 

5,000  10,000  to  20,000 

5.000  12,500  to  25,000 

5,000  15,000  to  30,000 

"Amount   payable   depends    upon   the   nature  of  the  loss  as  set  forth   in  the  policy. 

Administered   by 
J.    L.   CRUMPTON,  State   Mgr. 
Professional    Group    Disability    Division 
Box    147,   Durham,   N.   C. 

J.  Slade  Crumpton,   Field   Representative 
UNDERWRITTEN    BY   THE  COMMERCIAL   INSURANCE  COMPANY  OF  NEWARK,  N.  J. 

Originator   and    pioneer   in    professional    group    disability    plans. 


Accident    and 

Annual 

Semi-Annual 

Annual 

Semi-Annual 

Sickness    Benefits 

Premium 

Premium 

Premium 

Premium 

50.00  Weekly 

$   78.00 

$  39.50 

$104.00 

$   52.50 

75.00  Weekly 

1  14.00 

57.50 

152.00 

76.50 

100.00  Weekly 

150.00 

75.50 

200.00 

100.50 

125.00  Weekly 

186.00 

93.50 

248.00 

124.50 

150.00  Weekly 

222.00 

111.50 

296.00 

148.50 

July,   1960 


SPECIAL  REPORT 


287 


a  project  to  study  and  encourage  the   em- 
ployment of  the  physically  handicapped. 

Allied  Health  Groups 

The  House  approved  the  final  report  of 
the  Committee  to  Study  the  Relationships 
of  Medicine  with  Allied  Health  Professions 
and  Services  and  commended  it  as  "  a  mon- 
umental work."  The  report  covers  the  pre- 
sent situation,  future  implications  and  re- 
commendations, including  guiding  princi- 
ples and  approaches  to  activate  physician 
leadership.  The  House  strongly  recom- 
mended that  A.  M.  A.  activity  in  this  vital- 
ly important  area  be  continued,  and  it  ap- 
proved the  appointment  of  a  Board  of 
Trustees  committee  to  carry  on  the  work. 

To  develop  physician  leadership  in  pro- 
moting cooperative  efforts  with  allied 
health  professions  and  services,  the  report 
suggested  the  following  A.  M.  A.  activities. 

1.  A  general  conference  should  be  held 
with  allied  scientists  in  the  basic  med- 
ical sciences  and  related  disciplines  for 
discussion  of  matters  of  common  con- 
cern related  to  the  creation  of  perma- 
nent, cooperative  activities. 

2.  Specific  exploratory  conferences  should 
be  held  with  members  of  segments  of 
science  allied  to  a  given  area  of  med- 
ical practice  with  the  national  medical 
organizations  concerned. 

3.  General  and  specific  conferences  should 
be  held  with  professional  and  technical 
assistants  on  education,  recruitment, 
and  coordination  of  contributions. 

4.  Through  meetings  and  publications, 
reciprocal  exchange  of  information 
should  be  provided  between  physicians 
and  allied  scientists  and  members  of 
health  professions. 

5.  Effective,  continuing  liaison  should  be 
established  between  A.  M.  A.  repre- 
sentatives and  professional  and  tech- 
nical personnel. 

National  Foundation 

The  House  took  two  actions  involving  re- 
lations between  the  medical  profession  and 
the  National  Foundation.  It  adopted  a  state- 
ment of  policies  for  the  guidance  of  state 
medical  associations  and  recommended  that 
they  be  adopted  by  all  component  medical 
societies.  These  policies  cover  such  subjects 
as  membership  of  medical  advisory  commit- 


tees, and  basic  principles  concerning  finan- 
cial assistance  for  medical  care,  payment 
for  physicians'  services  and  physicians'  re- 
sponsibilities for  constructive  leadership  in 
medical  advisory  activities. 

In  another  action  the  House  directed  the 
Board  of  Trustees  to  authorize  further 
conferences  with  leaders  in  the  National 
Foundation  on  the  problem  of  poliomyelitis 
as  it  relates  to  the  betterment  of  the  public 
health  and  to  consider  further  joint  action 
toward  the  eradication  of  polio.  The  House 
commended  the  National  Foundation  for  its 
outstanding  service  in  the  attack  against 
polio,  but  pointed  out  that  much  work  re- 
mains to  be  done  in  public  education,  vac- 
cination, continuing  assistance  for  polio  vic- 
tims, and  research. 

Miscellaneous  Actions 

In  dealing  with  reports  and  resolutions 
on  a  wide  variety  of  other  subjects,  the 
House  also: 

Strongly  reaffirmed  its  support  of  the 
Blue  Shield  concept  in  voluntary  health  in- 
surance and  approved  specific  recommenda- 
tions concerning  A.  M.  A. — Blue  Shield  re- 
lationships; 

Approved  a  contingent  appointment  of 
not  more  than  six  months  for  foreign  med- 
ical school  graduates  who  have  been  ac- 
cepted for  the  September,  I960,  qualifica- 
tion examination ; 

Agreed  that  the  American  Medical  Asso- 
ciation should  sponsor  a  second  National 
Congress  on  prepaid  health  insurance; 

Approved  a  Board  of  Trustees  request  to 
the  Postmaster  General  for  a  stamp  com- 
memorating the  Mayo  Brothers; 

Decided  that  the  establishment  of  a  home 
for  aged  and  retired  physicians  is  not  war- 
ranted at  this  time. 

Approved  the  establishment  of  a  new 
"Scientific  Achievement  Award"  to  be 
given  to  a  non-physician  scientist  on  special 
occasions  for  outstanding  work; 

Approved  the  following  schedule  for  fu- 
ture annual  meetings :  Atlantic  City,  1963 ; 
San  Francisco,  1964,  and  New  York  City, 
1965; 

Approved  the  objectives  of  the  A.  M.  A. 
Commission  on  the  Cost  of  Medical  Care 
established  by  the  Board  of  Trustees  and 
headed  by  Dr.  Louis  M.  Orr,  immediate 
past  president  of  the  Association ; 

Urged  individual  members  of  the  Asso- 
ciation to  take  a  greater  interest  and  more 


288 


NORTH  CAROLINA   MEDICAL  JOURNAL 


July.   19G0 


active  part  in  public  affairs  on  all  levels; 

Reaffirmed  its  opposition  to  compulsory 
inclusion  of  physicians  under  Title  II  of 
the  Social  Security  Act  and  recommended 
immediate  action  by  all  A.  M.  A.  members 
who  agree  with  that  position ; 

Called  for  a  review  of  existing  and  pro- 
posed legislation  pertaining  to  food  unci 
color  additives,  with  the  objection  of  sup- 
porting appropriate  measures  which  are  in 
the   public   interest; 

Urged  reform  of  the  federal  tax  struc- 
ture so  as  to  return  to  the  states  and  their 
political  subdivisions,  their  traditional  re- 
venue sources; 

Asked  state  and  county  medical  societies 
to  make  greater  use  of  A.  M.  A.  recruit- 
ment materials  in  presenting  medicine's 
story  to  the  nation's  high  schools ; 

Requested  the  Board  of  Trustees  to  ini- 
tiate a  study  of  present  policy  regarding 
the  required  content  and  method  of  prepar- 
ing hospital  records; 

Commended  the  Department  of  Defense 
and  the  Air  Force  for  establishing  and  op- 
erating the  Aeromedical  Transport  Service 
and  urged  that  it  be  maintained  at  optimum 
efficiency ; 

Directed  the  Board  of  Trustees  to  devel- 
op group  annuity  and  group  disability  in- 
surance programs  for  Association  mem- 
bers; and 

Expressed  grave  concern  over  the  indis- 
criminate use  of  contact  lenses. 

Addresses  and  Awards 

Dr.  Orr,  in  his  final  report  to  the  House 
at  the  opening  session,  urged  medical  so- 
cieties to  "adopt"  rural  villages,  cities,  and 
regions  in  underdeveloped  parts  of  the 
world  and  to  send  them  medical,  clinical, 
and  hospital  supplies. 

Dr.  Askey,  in  his  inaugural  address 
Tuesday  night,  declared  that  medicine  faces 
its  greatest  challenge  in  the  decade  ahead, 
adding  that  physicians  must  prove  the  ef- 
fectiveness of  medicine  practiced  in  a  free 
society.  Dr.  John  S.  Millis  (Ph.D.),  presi- 
dent of  Western  Reserve  University,  Cleve- 
land, Ohio,  and  guest  speaker  at  the  in- 
augural ceremonies,  said  the  human  dilem- 
ma of  the  sixties  is  an  increasing  desire  for 
security  and  authority  with  a  diminishing 
desire  for  responsibility. 

At  the  Wednesday  session  of  the  House, 
Dr.  Askey  urged  intensified,  accelerated  ef- 


fort in  five  areas  —  medical  education, 
preparations  for  the  White  House  Confer- 
ence on  Aging  next  January,  health  insur- 
ance and  third  party  relationships,  mental 
health,  and  membership  relations. 

The  Goldberger  Award  in  Nutrition  was 
presented  to  Dr.  Richard  Vilter  of  the  Uni- 
versity of  Cincinnati.  The  Boy  Scouts  of 
America,  celebrating  its  golden  jubilee, 
presented  the  A.  M.  A.  with  a  citation  in 
appreciation  of  the  medical  profession's 
help  and  support.  Dr.  B.  E.  Pickett  of  Car- 
rizo  Springs,  Texas,  retiring  chairman  of 
the  Council  on  Constitution  and  Bylaws, 
received  an  award  in  recognition  of  his 
long  service. 

Election  of  Officers 

In  addition  to  Dr.  Larson,  the  new  pres- 
ident-elect, the  following  officers  were 
named  at  the  Thursday  session : 

Dr.  William  F.  Costello  of  Dover,  N.  J., 
vice  president;  Dr.  Norman  A.  Welch  of 
Boston,  re-elected  speaker  of  the  House, 
and  Dr.  Milford  0.  Rouse  of  Dallas,  Texas, 
re-elected  vice  speaker. 

Dr.  Gerald  D.  Dorman  of  New  York  City 
was  elected  to  the  Board  of  Trustees  to  suc- 
ceed Dr.  Larson,  and  Dr.  James  Z.  Appel  of 
Lancaster,  Pennsylvania,  was  re-elected  to 
the  Board. 

Elected  to  the  Judicial  Council,  to  suc- 
ceed Dr.  Louis  A.  Buie  of  Rochester, 
Minnesota,  was  Dr.  James  H.  Berge  of 
Seattle. 

Named  to  the  Council  on  Medical  Educa- 
tion and  Hospitals  were  Dr.  William  R. 
Willard  of  Lexington,  Kentucky,  succeed- 
ing Dr.  James  M.  Faulkner  of  Cambridge, 
Massachusetts,  and  Dr.  Harlan  English  of 
Danville,  Illinois,  who  was  re-elected. 

On  the  Council  on  Medical  Service,  the 
House  re-elected  Dr.  Russell  B.  Roth  of 
Erie,  Pennsylvania,  and  Dr.  Hoyt  B.  Wool- 
ley  of  Idaho  Falls. 

Dr.  George  D.  Johnson  of  Spartanburg, 
S.  C,  was  named  to  succeed  Dr.  Pickett  on 
the  Council  on  Constitution  and  Bylaws. 

F.  J.  L.  Blasingame,  M.D. 
Executive  Vice  President 
American   Medical  Association 


July,   1960 


EDITORIALS 


289 


North  Carolina  Medical  Journal 

Owned  and   published   by 

The  Medical  Society  of  the  State  of  North  Carolina, 

under  the  direction  of  its  Editorial  Board. 

EDITORIAL   BOARD 
Wingate  M.  Johnson,  M.D.,  Winston-Salem 

Editor 
Miss  Louise  MacMillan,  Winston-Salem 

Assistant  Editor 
Mr.  James  T.  Barnes,  Raleigh 

Business  Manager 
Ernest  W.   Furgurson,   M.D.,   Plymouth 
John  Borden  Graham,  M.D.,  Chapel   Hill 
G.   Westbrook   Murphy,   M.D.,  Asheville 
William   M.  Nicholson,   M.D.,   Durham 
Robert  W.  Prichard,  M.D.,  Winston-Salem 
Hubert  A.   Royster,   M.D.,   Raleigh 

Address  manuscripts  and  communications  regarding 
editorial  matter  to  the 
NORTH  CAROLINA  MEDICAL  JOURNAL 
300  South  Hawthorne  Road,  Winston-Salem  7,  N.  C. 
Questions  relating  to  subscription  rates,  advertis- 
ing, ect.,  should  be  addressed  to  the  Business 
Manager,  203  Capital  Club  Building,  Raleigh,  N.  C. 
All  advertisements  are  accepted  subject  to  the  ap- 
proval of  a  screening  committee  of  the  State 
Journal  Advertising  Bureau,  510  North  Dearborn 
Street,  Chicago  10,  Illinois,  and/or  by  a  Committee 
of  the  Editorial  Board  of  the  North  Carolina  Medi- 
cal Journal  in  respect  to  strictly  local  advertising 
accepted  for  appearance  in  the  North  Carolina 
Medical  Journal. 

Annual  subscription,  $5.00  Single  copies,  75'' 

Publication    office:    Carmichael    Printing    Co.,    1309 

Hawthorne  Road,  S.W.,  Winston-Salem  1,  N.  C. 

JULY,    1960 


THE   A.M.A.'s  ONE  HUNDRED   NINTH 
ANNUAL  MEETING 

The  actions  of  the  A.M. A.  House  of  Dele- 
gates are  published  elsewhere  in  this  issue, 
so  only  a  few  random  impressions  will  be 
given  here. 

The  total  registration  was  22,484,  in- 
cluding 8,162  physicians.  This  was  far  be- 
low last  year's  Atlantic  City  mark  of  32,882, 
including  13,143  physicians.  Doubtless  the 
strike  of  Eastern  Airline  pilots  called  just 
before  the  opening  day  of  the  meeting  was 
partly  responsible  for  this  falling  off  in 
attendance.  Without  disparaging  the  hos- 
pitality of  the  Florida  medical  profession, 
however,  it  must  be  admitted  that  Miami 
Beach  was  far  from  an  ideal  convention 
site.  The  distance  from  the  headquarters 
hotel,  the  Americana,  to  the  exhibition  hall 
was  7  miles  and  required  45  minutes  or 
more  on  one  of  the  buses  provided  for 
transportation.  The  section  meetings  were 
widely  scattered,  and  many  doctors  were 
heard  to  express  the  same  nostalgic  feeling 


for  Atlantic  City  that  members  of  our  State 
Society  had  expressed  for  Pinehurst. 

The  scientific  and  technical  exhibits  were 
good,  although  not  as  well  attended  as  they 
would  have  been  in  a  more  favorable  loca- 
tion. Both  Dr.  Orr  in  his  farewell  address 
and  Dr.  Askey  in  his  inaugural  address 
did  themselves  proud. 

The  election  of  Dr.  Leonard  Larson  as 
president-elect  met  with  universal  approv- 
al. He  has  richly  earned  this  honor  and  can 
be  depended  upon  to  carry  on  the  good  work 
of  his  predecessors. 

Our  neighboring  state,  South  Carolina, 
was  well  recognized.  Dr.  Julian  Price  of 
Florence  was  selected  chairman  of  the 
Board  of  Trustees  to  succeed  Dr.  Larson. 
Dr.  George  Johnson  of  Spartanburg  was 
elected  to  succeed  Dr.  B.  E.  Pickett  of  Texas 
as  a  member  of  the  Council  on  Constitution 
and  By-laws.  Dr.  Pickett  was  given  a  stand- 
ing ovation  when  he  gave  his  final  report 
as  chairman  of  this  important  Council. 


THE  OLD  ORDER  CHANGETH 
Dr.  Alfred  Potter's  Presidential  Address, 
delivered  at  the  one  hundredth  forty-ninth 
Annual  Meeting  of  the  Rhode  Island  Med- 
ical Society  and  published  in  the  June  issue 
of  the  Rhode  Island  Medical  Journal,  is 
scholarly  and  thought-provoking.  As  the 
one  hundredth  president  of  the  Rhode 
Island  Society,  Dr.  Potter  noted  some  of  the 
most  important  changes  in  medical  prac- 
tice that  have  occurred  in  the  society's  his- 
tory. 

He  began  by  citing  the  record  from  the 
Providence  Lying-in  Hospital  of  a  patient 
delivered  by  the  matron.  Since,  fortunately 
for  the  patient,  "Because  of  the  Sunday 
horsecar  delay  the  doctor  was  not  present 
.  .  .  The  patient's  course  was  remarkable  in 
that  at  no  time  had  the  temperature  risen 
above  100."  At  that  time  the  words  of 
Holmes  and  Semmelweiss  had  fallen  on 
deaf  ears. 

Dr.  Potter  commented  that  the  economics 
of  medicine  had  changed  as  much  as  our 
mode  of  transportation  and  our  therapy. 
More  and  more  people  depend  on  insurance, 
and  the  depression  era  5  to  1  ratio  of  serv- 
ice to  private  patient  has  been  reversed. 
With  the  great  increase  in  insurance,  fees 
for  medical  service  are  being  standardized. 
Dr.  Potter  deplores  "the  leveling  of  all 
doctors  to  a  median  payment"  as  "leading 


290 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July,  I960 


only  to  a  dead  level  of  mediocrity."  He 
equally  deplores,  however,  overcharging  pa- 
tients, and  is  concerned  because  "it  seems 
that  of  late  years  more  persons  than  form- 
erly have  entered  medicine  for  financial 
betterment  or  for  status." 

Two  paragraphs  deserve  quoting  in  full: 

The  infrequent  overcharging  or  other  wrong- 
doing in  the  way  of  unprofessional  conduct  by 
a  few  brings  discredit  on  all.  To  minimize  this 
situation  we  must  be  more  than  ever  alert  to 
police  our  own  profession.  The  general  public 
seems  ready  to  believe  the  worst  of  us, 
without  waiting  to  have  the  evidence  presented 
and  proved.  From  the  very  nature  of  our  calling, 
the  fact  that  we  are  usually  employed  only  at  a 
time  of  illness,  suffering,  anxiety,  or  grief,  all 
unpleasant  emotions,  makes  us  by  association  the 
objects  of  unconscious  disapproval  and  hostility. 
Enricus  Cordus  expressed  this  common  feeling 
as  far  back  as  1535  in  these  lines: 

"Three   faces    wears   the    doctor;    when  first 

sought, 
An  Angel's,  .  .  .  And   a   God's   the   cure   half 

wrought ; 
But   when   the   cure    complete,   he   seeks   his 

fee, 
The   Devil  looks  less   terrible   than   he." 

I  believe  that  a  large  part  of  the  hostility 
toward  medicine,  outspoken  by  labor  leaders,  and 
rampant  in  many  newspapers,  is  based  on  envy; 
envy  of  the  doctor's  independence.  "We  few,  we 
happy  few,  we  band  of  brothers"  are  of  the  few 
remaining  self-employed.  We  are  not  retired  at 
an  arbitrarily  fixed  age  while  still  fully  or  even 
better  able  to  continue  working.  We  may  work 
as  long  and  as  many  hours  as  we  want  or  as  our 
health  permits.  Having  proved  our  competence 
to  practice  we  are  not  displaced  by  changing 
production  methods  or  economic  upheavals.  We 
have  security,  but  only  if  we  keep  our  health 
and  maintain  and  enlarge  our  skills  with  new- 
knowledge.  In  a  way  we  live  dangerously,  with 
no  pension  plans  paid  for  by  an  employer.  But 
we  are  our  own  masters,  and  I  believe  that  for 
this  reason  we  are  envied  by  our  detractors.  At 
the  same  time,  it  is  important  to  remember  that 
this  freedom  carries  with  it  great  responsibil- 
ties. 

Dr.  Potter  found  some  comfort,  after  he 
had  almost  finished  writing  his  address, 
from  reading  in  the  1912  Presidential  Ad- 
dress of  Dr.  Frederick  Rogers : 

"How  shall  we  regain  the  respect,  the 
feeling-  of  security  and  confidence  in  the 
medical  profession  which  was  such  a  strong 
factor  in  human  life  a  hundred  years  ago, 
but  which  now  is  unfortunately  lacking?" 


And  it  is  quite  likely  that  a  hundred 
years  before  Dr.  Rogers  asked  this  ques- 
tion, the  more  sensitive  and  intelligent 
leaders  of  the  profession  were  still  smart- 
ing from  the  caricature  of  doctors  found  in 
Moliere's  writings  and  in  Hogarth's  paint- 
ings. Now,  as  then,  our  profession's  most 
effective  public  relations  can,  in  Dr.  Pot- 
ter's concluding  words,  "best  be  regained 
and  maintained  by  our  individual  and  per- 
sonal contacts  with  our  patients  and  other 
laymen." 


"SYMPTOMATIC   MEDICINE" 

"Symptomatic  medicine"  has  acquired 
the  reputation  of  poor  medicine,  of  the  dis- 
pensing of  a  series  of  pills  to  relieve  a  suc- 
cession complaints  in  a  patient  with  an 
undiagnosed  or  incurable  illness.  It  is  gen- 
erally referred  to  apologetically  by  the  doc- 
tor in  charge  of  the  case,  or  condescending- 
ly or  scathingly  by  another  doctor  review- 
ing the  case.  Is  such  an  attitude  justified? 
Why  should  not  the  patient's  symptoms  be 
relieved? 

The  present  century,  because  of  the  as- 
tounding advances  in  diagnostic  techniques 
and  in  surgical  and  pharmacologic  methods 
of  cure,  has  witnessed  a  change  in  the  goal 
of  the  medical  profession.  Cure  of  the  dis- 
ease, or,  if  that  is  not  possible,  restoration 
of  maximum  function  is  now  the  aim, 
rather  than  alleviation  of  suffering  while 
the  disease  runs  its  course  in  the  patient. 
It  is  true  that  if  the  disease  is  properly 
diagnosed,  and  if  a  specific  remedy  is  avail- 
able and  properly  prescribed,  then  the 
symptoms  caused  by  the  disease  will  abate 
and  eventually  disappear  as  the  disease  is 
healed,  and  a  change  in  the  symptoms  may 
be  a  useful  gauge  of  the  progress  of  the 
treatment. 

But  what  of  the  many  symptoms  caused 
by  "stress"  or  "tensions"  or  by  unknown 
disorders?  The  patient  may  obtain  some  re- 
lief by  learning  that  his  headache  is  caused 
by  tension  or  sinusitis  rather  than  the 
brain  tumor  he  feared,  but  he  will  still  ex- 
pect some  more  direct  relief  while  awaiting 
the  benefits  of  measures  directed  toward 
the  underlying  condition.  If  such  relief  is 
not  forthcoming,  the  less  tolerant  or  less 
patient  patient   will   seek  help   elsewhere — 

Reprinted    from    the    Journal    of    the     Florida     Medical     Asso- 
ciation   46:1262-1253     (April)     1960. 


July,   1960 


EDITORIALS 


291 


which  explains   why   the  quack  and   cultist 
still  flourish  in  this  age  of  medical  miracles. 

One  other  point  should  be  made.  It  is 
often  thought  that  "symptomatic  medicine" 
is  easy — that  the  relief  of  a  symptom  in- 
volves a  thorough  grounding  not  only  in 
physiology  but  also  in  the  psychology  of  the 
doctor  as  well  as  the  patient,  and  prescrib- 
ing for  the  symptoms  presupposes  an  up  to 
date  knowledge  of  pharmacology. 

The  relief  of  symptoms  is  still  the  prin- 
cipal desire  of  patients  coming  to  the  phy- 
sician. There  should  be  no  shame  or  stigma 
attached  to  granting  such  relief,  provided 
the  cause  of  the  symptoms  is  understood. 
For  a  remarkably  lucid  and  complete  ex- 
position on  this  subject  the  interested  read- 
er is  referred  to  Dr.  Walter  ModelPs  mon- 
ograph.'1* 

1.    Modell,     Walter:      The     Relief     of     Symptoms,     Philadelphia, 
W.    B.    Saunders    Company,    1955. 


NURSES  AND  NURSING 

No  doubt  many  doctors  will  say  a  hearty 
"Amen"  to  Miss  Vivian  Culver's  paper  in 
this  issue  of  the  Journal.  Many  nurses,  also, 
have  been  concerned  about  the  trend  in 
nursing  education  to  emphasize  the  theory 
of  nursing  at  the  expense  of  patient  care. 
As  Miss  Culver  expressed  it,  we  are  short 
of  both  nurses  and  nursing. 

It  is  true  that  more  and  more  nurses  are 
expected  to  carry  out  procedures  formerly 
done  only  by  doctors — such  as  taking  blood 
pressures.  Parenthetically,  this  plan  has  the 
great  advantage  that  nursing  ministrations 
are  so  taken  for  granted  by  the  average  pa- 
tient that  almost  as  a  rule  the  pressures 
taken  by  the  nurse  are  lower  than  those 
taken  by  the  doctor. 

There  has  been  a  regrettable  tendency  to 
exalt  the  administrative  role  of  the  nurse 
at  the  expense  of  the  active  nursing  care  of 
the  patient.  Both  types  of  nurses  are 
needed,  and  both  are  important.  The  nurse 
who  really  enjoys  patient  care,  however, 
should  not  be  made  to  feel  inferior  to  the 
supervisor  type. 

What  the  late  Francis  Peabody  said  of 
the  medical  practice  applies  equally  well  to 
nursing:  "The  secret  of  the  care  of  the  pa- 
tient is  caring  for  the  patient." 


MEDICAL  PREPAYMENT  AND 
OUR  SOCIAL  PHILOSOPHY 

"A  curious  paradox  of  some  contem- 
porary social  philosophy  is  the  idea  that 
man  should  spend  what  he  earns  for  his 
pleasures  rather  than  for  what  he  needs. 
It  is  appropriate,  so  this  reasoning  goes, 
that  he  should  buy  a  television  set,  a  vaca- 
tion in  Florida  or  an  outboard  motor  boat, 
because  there  are  cardinal  rights.  But  for 
something  that  he  really  needs,  such  as  his 
life  or  his  health,  or  the  life  of  his  child, 
someone  else  should  pay.  This  may  be  the 
Government,  his  employer,  his  union,  his 
great-aunt  or  anyone  else  who  can  be  ca- 
joled or  coerced  into  paying  the  price  for 
him.  If  no  one  else  will  pay  for  it,  the 
doctor  should  serve  him  for  nothing." 

This  observation  by  Dr.  C.  Marshall  Lee, 
Jr.,111  raises  a  question  of  crucial  impor- 
tance not  only  to  the  medical  economy  but 
to  the  whole  pattern  of  our  American  so- 
ciety. 

For,  as  Dr.  Lee  puts  it,  the  attitude  he 
describes  "may  be  acceptable  for  the  child 
of  an  indulgent  parent,  but  it  is  not  appro- 
priate for  a  free  man  in  a  free  society." 

What  can  the  doctor  do  to  counteract 
this  philosophy  and  to  forestall  the  social- 
ization of  medicine  which  may  be  its  ulti- 
mate product? 

First,  the  doctor  should  learn  all  he  can 
learn  about  our  voluntary  medical  prepay- 
ment programs.  Physicians  should  recog- 
nize that,  in  Dr.  Lee's  words,  "Far  from 
being  the  meddlesome  'third  party'  for 
which  they  have  an  uneasy  fear,  (the  pre- 
payment program)  stands  with  them  in  the 
common  effort  to  preserve  a  cherished 
concept  of  freedom." 

Secondly,  the  doctors — and  only  he — can 
make  these  programs  operate  to  the  satis- 
faction of  the  patient.  Only  he  can  see  to  it 
that  the  subscriber  gets  full  value  for  the 
premium  dollar  he  has  invested  in  our  vol- 
untary medical  care  program. 

Finally,  the  medical  profession's  own 
sponsored  Blue  Shield  Plans  offer  the 
American  doctor  an  opportunity  not  only 
to  strengthen  and  confirm  his  patient's 
confidence  in  our  traditional  way  of  prac- 
ticing medicine,  but  also  to  participate 
actively  in  guiding  the  destiny  of  our  med- 
ical prepayment  program  in  the  days  ahead. 


292 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July.   1960 


CORRESPONDENCE 
To  the  Editor: 

Recently  I  received  from  the  Board  of 
Medical  Examiners  of  the  State  of  North 
Carolina  a  pamphlet  listing  the  registered 
physicians  in  the  state  of  North  Carolina. 
Although  I  did  not  count  the  exact  number 
registered  I  estimated  that  approximately 
five  thousand  physicians  were  registered  in 
this  pamphlet.  It  appears  that  the  intake 
from  this  project  is  amounting  to  over  $25 
thousand. 

In  the  foreword  in  this  pamphlet  the 
Board  of  Medical  Examiners  of  the  State 
are  nice  enough  to  give  an  exact  copy  of  the 
law  wherein  this  taxation  is  ordered.  How- 
ever, I  do  not  read  in  the  law  as  published 
any  direction  wherein  money  will  be  spent 
from  this  collection  to  publish  and  mail  out 
a  pamphlet  such  as  I  have  received.  As  I 
am  a  member  of  the  North  Carolina  Med- 
ical Society  I  find  that  the  roster  which  is 
published  by  the  Society  is  much  more  con- 
venient and  comprehensive  as  to  the  infor- 
mation on  doctors  in  North  Carolina.  In 
fact,  the  pamphlet  as  put  out  by  the  Board 
of  Medical  Examiners  is  grossly  lacking  in 
the  information  and  consequently  will  serve 
no  purpose  due  to  the  fact  that  the  roster 
published  by  the  Medical  Society  is  better. 

How  many  years  will  the  physicians  of 
North  Carolina  have  to  be  bled  for  $25 
thousand  or  more  every  two  years  for  them 
to  finally  realize  that  this  is  just  another 
unnecessary  taxation   placed   upon  them? 

I  sincerely  hope  that  you  will  take  some 
steps  to  bring  this  matter  before  the  mem- 


bership of  the  North  Carolina  Medical  So- 
ciety in  an  effort  to  get  them  to  voice  their 
feeling  on  this  taxation  and  to  take  a  firm 
stand  on  its  approval  or  disapproval.  If  the 
consensus  is  toward  approval  then  it  should 
be  so  stated.  If  the  voice  is  for  disapproval 
then  I  think  the  Medical  Society  JOURNAL 
should  be  the  place  for  the  beginning  of  a 
campaign  to  have  this  law  removed  with  all 
expediency. 

The  internal  revenue  department  knows 
the  physicians  of  the  state,  the  military 
knows  the  names  of  the  physicians  it  may 
need,  the  North  Carolina  Medical  Society 
has  a  roster  of  its  members,  the  North 
Carolina  Board  of  Medical  Examiners  now 
have  a  complete  list  of  the  physicians  of 
the  state,  so  now,  who  can  defend  the  per- 
petuation of  this  unfair  and  unnecessary 
piece  of  legislation? 

J.  R.  Gamble,  Jr.,  M.D. 

Lincolnton 

Note :  The  Biennual  Registration  Act 
was  recommended  after  long  deliberation 
by  the  Board  of  Medical  Examiners,  and 
adopted  by  a  large  majority  of  the  dele- 
gates at  its  1956  meeting.  The  reasons  for 
it  were  given  by  Dr.  Combs  in  a  guest  edi- 
torial in  the  December,  1957,  issue.  Since 
the  North  Carolina  Medical  Journal  is 
the  official  organ  of  the  North  Carolina 
Medical  Society,  it  would  not  be  consistent 
for  it  to  lead  a  crusade  against  a  policy  ap- 
proved by  a  majority  of  our  House  of  Dele- 
gates. The  columns  of  the  Journal,  how- 
ever, are  open  to  any  members  who  wish  to 
give  their  views  on  this  or  any  other  action 
of  the  Society. — Ed. 


•  •••a      a  Greensboro 


•      »0  Raleigh 


Washington#Q       t~fi 


MATERNAL   DEATHS    REPORTED  IN  NORTH  CAR0L1NA\  / 

SINCE    JANUARY  I,   I960  \W"^.n9,onn- 


Each   dot  represents  one  death 


July,   19G0 


293 


Committees  and  Organizations 

SCHEDULE  OF  COMMITTEE  AND 
COMMISSION     APPOINTMENTS,     1960-1961 

NOTE:      The   Committees  listed  herein  have   been   authorized    by    President    Amos     N.     Johnson, 
and/or  are  required   under  the   Constitution  and   By-Laws. 

Particular  note  should  be  taken  of  the  authorization  of  the  House  of  Delegates  of 
a  Commission  form  of  organizational  activity  and  that  all  Committees,  excepting  Com- 
mittee on  Nomination,  Committee  on  Negotiation,  and  Committee  on  Grievances,  are  seg- 
regated under  the  respective  Commission  in  which  the  function  of  the  committee  log- 
ically rests.  This  will  tend  to  eliminate  overlapping  and  duplication  in  activity  programs 
and  result  in  coordination  of  the  work  of  the  Society  in  a  manner  to  lessen  the  work  of 
the  delegates  in  the  Annual  Meeting  of  the  House  of  Delegates. 

(The  President,  Secretary  and  Executive  Director  of  the  Society  are  ex-officio 
members  of  all  committees  and,  along  with  the  Commission  Chairman,  should  receive  no- 
tice of  meetings,  agenda   and  minutes   of   committee  meetings  during  the  activity  year.) 


I.         ADMINISTRATION    COMMISSION 

Wayne  J.   Benton,   M.D.,   Chairman 

2320  Battleground  Rd.  Committee 

Greensboro,    North    Carolina  listing 

1.  Finance,    Committee   on    (1-1)  #19 

Wavne  J.   Benton,   M.D.,   Chairman 
2320    Battleground    Rd. 
Greensboro,   North    Carolina. 

2.  Liaison  to  Study  Integration  of  Negro  #44 
Physicians  into  Medical  Society  of  State  of 
North    Carolina 

J.  Street  Brewer,  M.D.,  Chairman 

P.O.   Box  98 

Roseboro,  North  Carolina 

II.        ADVISORY   AND    STUDY    COMMISSION 

Jacob    H.    Shuford,    M.D.,    Chairman 
7  Main  Avenue  Place,  S.  W. 
Hickory,  North  Carolina 

1.  Auxiliary  Advisory  and  Archives  of  Medical 
Society  History,   Committee  on,    (II-l)  #1 

Roscoe  D.  McMillan,  M.D.,  Chairman 

P.  O.  Box  232 

Red   Springs,   North    Carolina 

2.  American   Medical    Education    Foundation, 
Committee   on,    (II-2)  #2 

Ralph   B.   Garrison,   M.D.,   Chairman 
222  N.  Main  Street 
Hamlet,   North   Carolina 

3.  Blue  Shield,  Committee  on  (II-3)  #8 
Jacob   H.    Shuford,   M.D.,   Chairman 

7  Main  Avenue  Place,  S.   W. 
Hickory,  North  Carolina 

4.  Constitution  and   By-Laws, 

Committee   on,    (II-4)  #13 

Roscoe  D.  McMillan,   M.D.,   Chairman 

Box  232 

Red  Springs,  North   Carolina 

5.  Credit   Bureau, 

Committee  on  Medical,   (II-5)  #14 

W.   Howard   Wilson,   M.D.,  Chairman 
403   Professional   Building 
Raleigh,   North   Carolina 

6.  Industrial    Commission    of    North    Carolina 
Committee   to   Work   with,    (II-6)  #23 
Thomas    B.    Dameron,    Jr.,    M.D.,    Chairman 
1313  Daniels  Street 

Raleigh,  North  Carolina 

7.  Medical  Care  of  Dependents  of   Members  of 
Armed    Forces,    (MEDICARE) 
Committee  on,   (II-7)  #28 
David  M.  Cogdell,  M.D.,  Chairman 

911   Hay   Street 
Fayetteville,   North   Carolina 


8.         Student   A.M.A.   Chapters, 

Committee  Advisory  to,   (II-8)  #41 

John   P.  Davis,  M.D.,  Chairman 
821   Nissen   Building 
Winston-Salem,    North    Carolina 

III.  ANNUAL   CONVENTION    COMMISSION 

R.    Beverly    Raney,    M.D.,   Chairman 
North    Carolina    Memorial    Hospital 
Chapel   Hill,   North   Carolina 

1.  Arrangements,   (of  Facilities   Annual 
Session),   Committee  on,    (III-l)  #4 
John   S.   Rhodes,   M.D.,   Chairman 

700  West  Morgan  Street 
Raleigh,  North  Carolina 

2.  Audio-Visual   Scientific   Postgraduate 
Instruction,   Committee   on,    (III-2)  #5 
J.   Leonard  Goldner,   M.D.,   Chairman 

Duke  Hospital 

Durham,   North    Carolina 

3.  Awards,   Committee  on,   (III-3)  #6 
To  be  announced  in   Fall 

4.  Delegates,   Committee    on    Credentials 

to  House  of   Delegates   (III-4)  #15 

T.   Tilghman   Herring,   M.D.,  Chairman 
Wilson   Clinic 
Wilson,  North   Carolina 

5.  Exhibits,   Committee  on   Scientific, 

(III-5)  #17 

Raphael   W.   Coonrad,   M.D.,   Chairman 
Broad   &  Englewood 
Durham,  North  Carolina 

6.  Golf   Tournament,   Committee   on 

Medical  (III-6)  #21 

Wm.  A.   Brewton,   M.D.,  Chairman 

5  Lake  Dr. 

Enka,   North   Carolina 

7.  Scientific   Works,   Committee   on    (III-7)        #7 
Wm.   McN.   Nicholson,   M.D.,   Chairman 
Duke  Hospital 

Durham,  North  Carolina 

IV.  PROFESSIONAL    SERVICE    COMMISSION 

George   W.    Paschal,   Jr.,    M.D.,   Chairman 
1110  Wake  Forest  Rd. 
Raleigh,  North  Carolina 

1.  Emergency   Medical    and   Military    Service 
Committee  on   (IV-1)  #16 
George  W    Paschal,  Jr.,   M.D.,   Chairman 
1110  Wake  Forest  Rd. 

Raleigh,   North    Carolina 

2.  Eye  Care  and  Eye  Bank, 

Committee  on   (IV-2)  #18 

George   T.   Noel,   M.D.,   Chairman 
211   Raleigh   Building 
Kannapolis,    North   Carolina 


294 


NORTH  CAROLINA  MEDICAL  JOURNAL 


July,   I960 


3.  Insurances,   Committee   on,    (IV-3)  #24 

Joseph   W.   Hooper,   Jr.,    M.D.,   Chairman 
410   North  11th   Street 
Wilmington,  North  Carolina 

4.  Necrology,  Committee  on,  (IV-4)  #30 
Charles    H.    Pugh,    M.D.,    Chairman 

Box   527 

Gastonia,  North  Carolina 

5.  Nursing,    Committee   of    Physicians    on, 
(IV-5)  #33 
Robert   R.    Cadmus,   M.D.,   Chairman 

N.  C.   Memorial   Hospital 
Chapel   Hill,   North    Carolina 

6.  Postgraduate   Medical   Study, 

Committee   on    (IV-6)  #35 

Samuel    L.    Parker,   Jr.,    M.D.,    Chairman 
Kinston  Clinic 
Kinston,   North   Carolina 

V.  PUBLIC    RELATIONS    COMMISSION 

Hubert    Mc.N.    Poteat,   Jr.,    M.D.,    Chairman 
713   Wilkins   Street 
Smithfield,    North    Carolina 

1.  Hospital    and    Professional    Relations    and 
Liaison   to   North   Carolina    Hospital 
Association,   Committee   on    (V-l)  #22 
Theodore   H.   Mees,   M.D.,   Chairman 

501   West  27th   Street 
Lumberton,    North    Carolina 

2.  Legislation,   Committee   on,    (V-2)  #25 
Hubert  McN.  Poteat,  Jr.,   M.D.,  Chairman 
713   Wilkins   Street 

Smithfield,    North    Carolina 

3.  Medical-Legal   Committee    (V-3)  #27 
Julius    A.    Howell,    M.D.,    Chairman 
Bowman   Gray    School    of    Medicine 
Winston-Salem,   North    Carolina 

4.  Public  Relations,  Committee  on  (V-4)  #37 
Edgar  T.  Beddingfield,  Jr.,  M.D.,  Chairman 
P.  O.   Box   137 

Stantonsburg,    North    Carolina 

5.  Rural   Health    and    General   Practitioner 
Award,    Committee    on    (V-5)  #39 
R.  Vernon  Jeter,   M.D.,   Chairman 
Plymouth  Clinic 

Plymouth,  North   Carolina 

6.  Insurance   Industry    Liaison   Committee        #43 
Frank   W    Jones,   M.D.,   Chairman 
Catawba  Hospital 

Newton,   North   Carolina 

VI.  PUBLIC    SERVICE    COMMISSION 

John   R.   Kernodle,   M.D.,   Chairman 
Kernodle   Clinic 
Burlington,    North    Carolina 

1.  Anesthesia  Study,  Committee  on,  (VI-1)  #3 
David   A.   Davis,   M.D.,  Chairman 

North    Carolina    Memorial   Hospital 
Chapel   Hill,   North    Carolina 

2.  Board  of  Public  Welfare  of  North   Carolina, 
Committee   Advisory    to,   (VI-2)  #9 
J.    Street    Brewer,    M.D.,    Chairman 

P.   O.   Box  98 

Roseboro,    North    Carolina 

3.  Cancer,  Committee  on,  (VI-3)  #10 
James    F.    Marshall,    M.D.,    Chairman 

310  West  4th  Street 
Winston-Salem,  North  Carolina 

4.  Child  Health,  Committee  on,  (VI-4)  #11 
Angus   M.   McBrvde,   M.D.,   Chairman 

809   West  Chapel   Hill   Street 
Durham,   North   Carolina 

5.  Chronic   Illness,    Tuberculosis    and    Heart 
Disease,   Committee  on,    (VI-5)  #12 
John   R.   Kernodle,    M.D.,   Chairman 
Kernodle   Clinic 

Burlington,   North    Carolina 


5.         Maternal   Health,  Committee  on,   (VI-6)      #26 
James   F.   Donnelly,   M.D.,   Chairman 
State  Board  of  Health 
Raleigh,  North  Carolina 

7.  Mental  Health,  Committee  on,  (VI-7)  #29 
AUvn    B.   Choate,    Ai.U.,   Chairman 

1012  Kings  Drive 
Charlotte,    North    Carolina 

8.  Occupational   Health,  Committee  on, 

(VI-8)  #34 

Hurry    L.   Johnson,    M.D.,    Chairman 

P.   O.   Box  530 

Elkin,   North   Carolina 

9.  Poliomyelitis,  Committee  on,  (VI-9)  #3fi 
Samuel   F.  Ravenel,  M.D.,  Chairman 

104   E.   Northwood   Street 
Greensboro,    North    Carolina 

10.  Rehabilitation    Physical, 

Committee  on   (VI-10)  #38 

George   W.    Holmes,    M.D.,    Chairman 
2240  Cloverdale  Avenue 
Winston-Salem,    North    Carolina 

11.  School  Health,  Committee  on,  (VI-11)  #40 
Irma   C.   Henderson   Smathers,   M.D., 

Chairman 
1295   Merrimon   Avenue 
Asheville,    North    Carolina 

12.  Veterans  Affairs,  Committee  on,  (VI-12)  #42 
Samuel    L.    Elfmon,    M.D.,    Chairman 

225  Green   Street 
Fayetteville,   North    Carolina 

VII.  NOMINATIONS,    COMMITTEE   ON    (not 
commission    constitutionally    provided)         #32 

Jacob  H.  Shuford,  M.D.,  Chairman 
7   Main  Ave.   Place,   S.W. 
Hickory,   North   Carolina 

VIII.  GRIEVANCES,  COMMITTEE  ON,  (not  a 
commission    By-Law    provided)  #20 

James  P.   Rousseau,   M.D.,   Chairman 
1014  W.   Fifth  Street 
Winston-Salem,   North   Carolina 

IX.  NEGOTIATIONS,  COMMITTEE  ON,  (not  a 
commission  By-Law  provided)  #31 
Wm.   F.  Hollister,   M.D.,  Chairman 

Moore   County   Hospital 
Pinehurst,    North    Carolina 
1.  Committee    Advisory    to    the   Auxiliary    and 

Archives  of  Medical  Society  History   (14}   II-l 
Roscoe   D.    McMillan,   M.D.,   Chairman,   Box 

232,   Red   Springs 
Ethel    May    Brownsberger,    M.D.,   75   Hender- 

sonville   Road,   Biltmore 
Warner  L.    Wells,   M.D.,   Consultant,   N.  C. 

Memorial   Hospital,   Chapel    Hill 
Coy  C.  Carpenter,  M.D.,  Consultant,  Bowman 

Gray,  Winston-Salem 
Wilburt  C.  Davison,  M.D.,  Consultant, 

Roaring  Gap 
Joseph   M.   Hitch,  M.D.,  415   Professional 

Bldg.,  Raleigh 
Wingate  M.  Johnson,  M.D.,  300  S.  Hawthorne 

Road,  Winston-Salem 
Rose   Pully.    M.D.,   1007^    N.    College    Street. 

Kinston 
Ivan    M.    Procter,    M.D.,    209    Hillcrest    Road, 

Raleigh 
Jean     Bailey     Brooks,     M.D  ,     1100     N.     Elm 

Street,   Greensboro 
James    P.    Rousseau,    M.D.,    1014    West    Fifth 

Street,    Winston-Salem 
Ben    F.    Royal,    M.D.,    900    Shepherd    Street, 

Morehead    City 


James    Tidier,   M.D., 

mington 
Paul     F.     Whitaker, 

Street,   Kinston 


1010   Grace    Street,   Wil- 
M.D.,     1205     N.     Queen 


July,   1960 


SCHEDULE  OF  COMMITTEE  APPOINTMENTS 


295 


Committee    on    American    Medical    Education 
Foundation    (AMEF)    (7)    II-2 

Ralph  B.  Garrison,  M.D.,  Chairman,  222  N. 
Main   Street,    Hamlet 

Wm.  LeRoy  Fleming,  M.D.,  UNC  School  of 
Medicine,   Chapel   Hill 

J.   Bivins   Helms,   M.D.,   Box  24,  Morganton 

Harry  L.   Johnson,   M.D.,   Box  530,   Elkin 

Paul  F.  Maness,  M.D.,  328  W.  Davis  Street, 
Burlington 

Manson  Meads,  M.D.,  Bowman  Gray,  Win- 
ston-Salem 

Wm.  Pettway  Peete,  M.D.,  Duke  Hospital, 
Durham 

Committee   on    Anesthesia    Study    Commission 
(11)   VI-1 

David  A.  Davis,  M.D.,  Chairman,  N.  C.  Mem- 
orial   Hospital,    Chapel   Hill 

Beverly  W.  Armstrong,  M.D.,  106  W.  7th 
Street,  Charlotte  2 

John  R.  Ashe,  Jr.,  M.D.,  624-A.  N.  Church 
Street,  Concord 

Horace  M.  Baker,  Jr.,  M.D.,  Medical  Arts 
Building,   Lumberton 

Samuel  R.  Cozart,  M.D.,  122  S.  Green  Street, 
Greensboro 

D.  LeRoy  Crandell,  M.D.,  Bowman  Gray, 
Winston-Salem 

Joseph  S.  Hiatt,  Jr.,  M.D.,  208  S.  W.  Broad 
Street,   Southern  Pines 

John  R.  Hoskins,  III,  M.D.,  203  Doctors 
Bldg.,  Asheville 

Will  Camp  Sealy,  M.D.,  Duke  Hospital,  Dur- 
ham 

Charles  R.  Stephen,  M.D.,  Box  3535,  Duke 
Hospital,    Durham 

Thomas  B.  Wilson,  M.D.,  Rex  Hospital 
Laboratory,    Raleigh 

Committee   on   Arrangements    (3) — (plus    3 
consultants)    III-l 

John  S.  Rhodes,  M.D.,  Chairman,  700  W. 
Morgan    Street,  Raleigh 

Theodore  S.  Raiford,  M.D.,  301  Doctors  Bldg., 
Asheville 

Walter  Spaeth,  M.D.,  116  South  Road  Street, 
Elizabeth   City 

George  Gilbert,  M.D.,  Consultant,  309  Doc- 
tors   Bldg.,   Asheville 

Robert  S.  Roberson,  M.D.,  Consultant,  102 
Brown  Avenue,  Hazelwood 

Jack  C.  Homer,  M.D.,  Consultant,  119  Hos- 
pital Drive,   Spruce  Pine 

Committee    on    Scientific   Audio-Visual 

Postgraduate   Instruction    (10)    III-2 

J.  Leonard  Goldner,  M.D.,  Chairman,  Duke 
Hospital,  Durham 

Lenox  D.  Baker,  M.D.,  Duke  Hospital,  Dur- 
ham 

H.  Frank  Starr,  M.D.,  Pilot  Life  Insurance 
Company,    Greensboro 

Gordon    M.     Carver,    Jr.,     M.D.,     1203     Broad 

Street,   Durham 

Joseph  F.  McGowan,  M.D.,  200  New  Medical 
Bldg.,    Asheville 

C.  Glenn  Sawyer,  M.D.,  Bowman  Gray,  Win- 
ston-Salem 

L.  Everett  Sawyer,  M.D.,  104  W.  Colonial 
Avenue,   Elizabeth    City 

J.  O.  Williams.  M.D.,  Cabarrus  Memorial  Hos- 
pital, Concord 

George  T.  Wolff,  M.D.,  Co-Chairman,  135 
Bishop    Street,    Greensboro 

Warner  L.  Wells,  M.D.,  N.  C.  Memorial  Hos- 
pital, Chapel   Hill 

Committee  on  Scientific  Awards  (10)  II 1-3 
(to  be  announced  in  Fall) 


9. 


Committee    on    Scientific    Works    (III-7)    (5)- 
(plus   Section   Chairmen    as   Consultants) 

Wm.  McN.  Nicholson,  M.D.,  Chairman,  Duke 
Hospital,   Durham 

Hubert  McN.  Poteat,  Jr.,  M.D.,  713  Wilkins 
Street,   Smithfield 

Paul  F.  Maness,  M.D.,  328  W.  Davis  Street, 
Burlington 

George  M.  Cooper,  Jr.,  M.D.,  2111  Clark 
Avenue,   Raleigh 

George  T.  Wolff,  M.D.,  135  Bishop  Street, 
Greensboro 

Consultants:    (1960-1961     Section    Chairmen) 

Julius  Sader,  M.D.  (Gen.  Practice  of  Medi- 
cine), 205   East  Main   Street,   Brevard 

Walter  Spaeth,  M.D.  (Internal  Medicine),  116 
South    Road    Street,  Elizabeth    City 

Charles  W.  Tillett,  M.D.,  (Ophthal  &  Otol), 
1511   Scott  Avenue,  Charlotte 

James  E.  Davis,  M.D.  (Surgery),  1200  Broad 
Street,  Durham 

Wm.  W.  Farley,  M.D.  (Pediatrics),  903  W. 
Peace   Street,  Raleigh 

Fleming  Fuller,  M.D.,  (Ob-Gyn),  Kinston 
Clinic,   Kinston 

Isa  C.  Grant,  M.D.  (Pub  Health  &  Ed),  3006 
Warren   Ave.,   Raleigh 

Myron  G.  Sandifer,  M.D.  (N&P),  N.  C. 
Memorial    Hospital,    Chapel   Hill 

Roger  W.  Morrison,  M.D.  (Pathology),  65 
Sunset   Parkway,   Asheville 

Charles  E.  Whitcher,  M.D.  (Anesthesia), 
300    Hawthorne    Rd.,    Winston-Salem 

Isadore  Meschan,  M.D.  (Radiology),  Bowman 
Gray,  Winston- Salem 

Chalmers  R.  Carr,  M.D.  (Ortho  &  Trauma- 
tology),  1822   Brunswick   Avenue,    Charlotte 

Mr.  John  Feagin  (Student  AMA),  Duke  Uni- 
versity  School   of   Medicine,  Durham 

Committee  on   Blue  Shield   (9)    II-3 

Jacob    H.     Shuford,    M.D.,    Chairman     (1962), 

7   Main   Avenue   Place,   S.   W.,   Hickory 
W.  Z.   Bradford,  M.D.,  (1961),  1509  Elizabeth 

Avenue,  Charlotte 
Willard   C.   Goley,   M.D.    (1962),   214   N.   Mar- 
ket Street,   Graham 
William    J.     Cromartie,    M.D.     (1963),     UNC 

School  of  Medicine,  Chapel  Hill 
John   R.  Hoskins,   III,   M.D.    (1963),  203   Doc- 
tors  Bldg.,   Asheville 
Julius  A.  Howell,  M.D.   (1961),  Bowman  Gray, 

Winston-Salem 
John  W.   Morris,  M.D.,    (1962),  1707   Arendell 

Street,   Morehead   City 
E.   Eugene    Menefee,   Jr.,    M.D.    (1963),    Duke 

Hospital,  Durham 
Max    P.     Rogers,    M.D.     (1961),    624    Quaker 

Lane,   High   Point 
Committee  Advisory   to  North   Carolina  State 
Board  of  Public  Welfare   (9)   VI-2 
J.    Street   Brewer,    M.D.,    Chairman,    Box    98 

Roseboro 
Bruce  B.   Blackmon,   M.D.,   Buies   Creek 
Stephen   R.    Bartlett,    Jr.,   M.D.,    1001    E.    4th 

Street,   Greenville 
Allyn    B.    Choate,    M.D.,    1012    Kings    Drive, 

Charlotte   2 
Clyde    R.     Hedrick,    M.D.,     104     North     Main 

Street,    Lenoir 
J.    Kempton    Jones,    M.D.,    1001    S.    Hamilton 

Road,    Chapel   Hill 
B.    Bruce    Langdon,    M.D.,    903    Hay    Street, 

Fayetteville 
Wm.    Raney    Stanford,     M.D.,     111     Corcoran 

Street,  Durham 
David     G.     Welton,     M.D.,     718     Professional 

Bldg.,    Charlotte   2 


296 


NORTH  CAROLINA   MEDICAL  JOURNAL 


July,   I960 


10.  Committee  on   Cancer    (12)    (Legal — 1    each 
Congressional   District)    VI-3 

James  F.  Marshall,  M.D.,  Chairman.  310  W. 
4th  Street,   Winston-Salem 

Wm.  H.  Bell.  Jr.,  M.D.  (3rd),  P.  O.  Box  1580, 
New   Bern 

Joshua  F.  B.  Camblos,  M.D.  (12th),  500  New 
Medical  Bldg.,  Asheville 

Charles  I.  Hams,  Jr.,  M.D.  (1st),  Martin 
General    Hospital,    Williamston 

Arthur  B.  Bradsher,  M.D.  (6th),  1200  Broad 
Street,   Durham 

Harry  V.  Hendrick,  M.D.  (11th),  Rutherford 
Hospital,   Rutherfordton 

Harold  A.  Peck,  M.D.  (8th),  Moore  Mem- 
orial   Hospital,   Pinehurst 

Charles  Glenn  Mock,  M.D.  (10th),  200  Haw- 
thorne Lane,  Charlotte 

David  L.  Pressly,  M.D.  (9th),  1025  Davie 
Street,  Statesville 

Samuel  L.  Parker,  Jr.,  M.D.  (2nd),  Kinston 
Clinic,   Kinston 

Hubert  McN.  Poteat,  Jr.,  M.D.  (4th),  713 
Wilkins    St.,    Smithfield 

D.  Ernest  Ward,  Jr.,  M.D.  (7th),  304  .Med- 
ical Arts   Building,   Lumberton 

11.  Committee  on   Child  Health    (9)    VI-4 
Angus   M.   McBryde,  M.D.,  Chairman,   809   W. 

Chapel   Hill    Street,   Durham 
P.  J.  McElrath,   M.D.,  500   St.   Mary's   Street, 

Raleigh 
Dan    P.     Boyette,    Jr.,    M.D.,     217     W.     Main 

Street,   Ahoskie 
Harrie   R.   Chamberlin,   M.D.,   UNC    School   of 

Medicine,  Chapel  Hill 
Jean   C.   McAlister,    M.D.,    104    E.    Northwood 

Street,    Greensboro 
John     W.    Nance,     M.D.,    401     Cooper    Drive, 

Clinton 
Wm.     H.     Patton,     Jr.,     M.D.,     305     College 

Street,   Morganton 
Robert   L.    Vann,    M.D.,    Bowman    Gray,   Win- 
ston-Salem 
Robert    F.    Poole,    Jr.,     M.D.,     817     Hillsboro 

Street,    Raleigh 

12.  Committee    on    Chronic    Illness.    Including 
Tuberculosis    and    Heart    Disease    (15)    VI-5 
John   R.   Kernodle,   M.D.,   Chairman,   Kernodle 

Clinic,   Burlington 

Stephen  R.  Bartlett,  Jr.,  M.D.,  1001  E.  4th 
Street,   Greenville 

Robert  H.  Dovenmuehle,  M.D.,  Duke  Hospi- 
tal, Durham 

John  D.  Fitzgerald,  M.D.,  409  Roxboro  Bldg., 
Roxboro 

Robert  L.  Garrard,  M.D.,  800  North  Elm 
Street,   Greensboro 

O.  David  Garvin,  M.D.,  Health  Department, 
Chapel   Hill 

Robert  A.  Gregg,  M.D.,  Central  Convalescent 
Hospital,   Greensboro 

Emery  T.  Kraycirik,  M.D.,  Box  1153,  Bur- 
lington 

Daniel  A.  McLaurin,  M.D.,  118  Main  Street, 
Garner 

Thomas  R.  Nichols,  M.D.,  206  N.  Sterling 
Morganton 

Elbert  L.  Persons,  M.D.,  Duke  Hospital, 
Durham 

John  L.  Shirey,  M.D.,  1  Battle  Square, 
Asheville 

George  L.  Verdone,  M.D.,  1012  Kings  Drive, 
Charlotte 

Donald  D.  Weir,  M.D  ,  N.  C.  Memorial  Hos- 
pital,  Chapel   Hill 

Wm.  H.  Flythe,  M.D.,  624  Quaker  Lane, 
High   Point 


13.       Committee    on    Constitution    and    By-Laws 
(5)   II-4 

Roscoe    D.     McMillan,     M.D.,    Chairman,    Box 

232,   Red  Springs 
Millard  D.  Hill,   M.D.,   15   W.   Hargett   Street, 

Raleigh 
Edward    W.    Schoenheit,    M.D.,    46    Haywood 

Street,   Asheville 
G.     Westbrook     Murphy,    M.D.,     103     Doctors 

Bldg.,    Asheville 
Louis  deS.   Shaffner,   M.D.,  300   S.   Hawthorne 

Road,   Winston-Salem 

1  I.       Committee   on    Medical    Credit    Bureaus    (7) 
II-5 

W.     Howard     Wilson,     M.D.,     Chairman,     403 

Professional   Bldg.,   Raleigh 
Fred    K.   Garvey,    M.D.,    Bowman    Gray,   Win- 
ston-Salem 
John     R.     Hoskins,     III,     M.D,     203     Doctors 

Bldg.,    Asheville 
Bob    Lewis    Fields,    M.D.,   Professional    Bldg., 

Salisbury 
Lockert     B.     Mason,     M.D.,     1006     Murchison 

Bldg.,   Wilmington 
Ross    S.    McElwee,    Jr.,    M.D.,    1340    Romany 

Road,   Charlotte 
Ralph    J.    Sykes,    M.D.,    205    Rawley    Avenue, 

Mt.    Airy 

15.  Committee   on    Credentials    of    Delegates    to 
House  of  Delegates    (5)    III-4 

T.  Tilghman  Herring,  M.D.,  Chairman,  Wil- 
son Clinic,  Wilson 

Milton  S.  Clark,  M.D.,  Wachovia  Bank  Bldg., 
Goldsboro 

James  E.  Hemphill,  M.D.,  1012  Kings  Drive, 
Charlotte 

Robert  M.  Whitley,  M.D.,  144  Coast  Line 
Street,   Rocky   Mount 

Charles  B.  Wilkerson,  M.D.,  100  S.  Boylan 
Avenue,  Raleigh 

16.  Committee   on   Emergency   Medical   and 
Military    Service    (8)    IV-1 

George  W.  Paschal,  Jr.,  M.D.,  Chairman, 
1110   Wake   Forest  Road,   Raleigh 

Chauncey  L.  Royster,  M.D.  Co-Chairman,  707 
W.   Morgan    Street,   Raleigh 

Zackary  F.  Long,  M.D.,  304  E.  Washington 
St.,   Rockingham 

Leslie  M.  Morris,  M.D.,  Medical  Building, 
Gastonia 

H.  Mack  Pickard,  M.D.,  7  N.  17th  Street, 
Wilmington 

Daniel  N.  Stewart,  Jr.,  M.D.,  3  Third  Ave- 
nue,  N.  W.,   Hickory 

Hugh  F.  McManus,  Jr.,  M.D.,  722  St.  Mary's 
Street,  Raleigh 

George  A.  Watson,  M.D.,  306  S.  Gregson 
Street,    Durham 

17.  Committee  on   Scientific   Exhibits    (7)    III-5 

Raphael  W.   Coonrad,   M.D.,  Chairman,   Broad 

&   Englewood    Sts.,   Durham 

Lenox    D.    Baker,    M.D.,    Co-Chairman,    Duke 

Hospital,    Durham 
Wm.     Henry     Boyce,     M.D.,     Bowman     Gray, 

Winston-Salem 
Thomas     B.    Daniel,     M.D.,     700     W.    Morgan 

Street,   Raleigh 
Erie   E.    Peacock,  Jr.,   M.D.,    N.    C.    Memorial 

Hospital,    Chapel   Hill 
O.     Norris     Smith,     M.D.,     1019     Professional 

Village,  Greensboro 
Vernon   H.    Youngblood,    M.D..    609    Kannapo- 

lis  Highway,   Concord 


July,   1960 


SCHEDULE  OF  COMMITTEE  APPOINTMENTS 


297 


18.  Committee   on    Eve    Care   and    Eye    Bank    (8) 
IV-2 

George      T.      Noel,      M.D.,      Chairman,      211 

Raleigh    Building,    Kannapolis 
Win.   Banks   Anderson,   M.D.,  Box   3802,  Duke 

Hospital,   Durham 
Horace   M.   Dalton,   M.D.,   400   Glenwood   Ave- 
nue, Kinston 
Louten     R.     Hedgpeth,     M.D.,     Medical     Arts 

Building,   Lumberton 
George     Levi,     M.D.,     802     Glenwood     Drive, 

Fayette  ville 
Edward   E.   Moore,    M.D.,  706   Flatiron    Bldg., 

Asheville 
J.    David    Stratton,    M.D.,   1012    Kings    Drive, 

Charlotte 
George    T.     Thornhill,     M.D.,     720    W.     Jones 

Street,   Raleigh 

19.  Committee  on    Finance    (3)    plus    consultants 
1-1 

Wayne  J.  Benton,  M.D.,  Chairman,  2320 
Battleground   Road,   Greensboro 

Lenox  D.  Baker,  M.D.,  Duke  Hospital,  Dur- 
ham 

Arthur  L.  Daughtridge,  M.D.,  Box  111, 
Rocky  Mount 

Alexander  Webb,  Jr.,  M.D.,  Consultant,  231 
Bryan   Bldg.,   Raleigh 

Graham  B.  Barefoot,  M.D.,  Consultant.  Box 
1198,   Wilmington 

Newsom  P.  Battle,  M.D.,  Consultant,  404 
Falls  Road,   Rocky  Mount 

Isaac  E.  Harris,  Jr.,  M.D.,  Consultant,  1200 
Broad   Street,   Durham 

Donald  B.  Koonce,  M.D.,  Consultant,  408  N. 
11th   Street,   Wilmington 

Malory  A.  Pittman,  M.D.,  Consultant,  Wil- 
son  Clinic,   Wilson 

James  P.  Rousseau,  M.D.,  Consultant,  1014 
West  Fifth   Street,   Winston-Salem 

O.  Norris  Smith,  M.D.,  Consultant,  1019  Pro- 
fessional  Village,  Greensboro 

Edward  W.  Schoenheit,  M.D.,  Consultant.  46 
Haywood   Street,   Asheville 

John  C.  Reece,  M.D.,  Consultant,  Grace 
Hospital,    Morganton 

A.  Hewitt  Rose,  Jr.,  M.D.,  Consultant,  2009 
Clark  Avenue,   Raleigh 

20.  Committee  on  Grievances    (5)    (1st   Five  Past 
Presidents)    VIII-0 

James  P.  Rousseau,  M.D.,  Chairman,  1014 
West   Fifth    Street,   Winston-Salem 

John  C.  Reece,  M.D.,  Secretary,  Grace  Hos- 
pital, Morganton 

Lenox  D.  Baker,  M.D.,  Duke  Hospital,  Dur- 
ham 

Edward  W.  Schoenheit,  M.D.,  46  Haywood 
Street,   Asheville 

Donald  B.  Koonce,  M.D.,  408  N.  11th  Street, 
Wilmington 

21.  Committee  on  Medical  Golf  Tournament 
(3)  III-6 

Wm.    A.    Brewton,    M.D.,    Chairman,    5    Lake 

Drive,  Enka 
Ralph  B.  Garrison,  M.D.,  222  N.  Main  Street, 

Hamlet 
Charles     W.    Styron,     M.D.,     615     St.     Mary's 

Street,   Raleigh 

22.  Committee  on  Hospital  and  Professional 
Relations  and  Liaison  to  North  Carolina 
Hospital   Association    (10)    V-l 

Theodore  H.  Mees,  M.D.,  Chairman  (5th), 
501  W.   27th  Street,  Lumberton 

Quinton  E.  Cooke,  M.D.,  (1st),  209  E.  Main 
Street,   Murfreesboro 

Paul  McNeely  Deaton,  M.D.,  (9th),  766  Hart- 
ness  Road,   Statesville 


John  Tyler  Dees,  M.D.,   (3rd),  Box  248,  Bur- 

gaw 
Frederick    C.    Hubbard,    M.D.    (8th),    Box   30, 

North    Wilkesboro 
H.   Lee   Large,  Jr.,   M.D.    (7th),   Presbyterian 

Hospital,   Charlotte 
Arthur   H.    London,   Jr.,    M.D.    (6th),    306    S. 

Gregson  Street,  Durham 
Wm.    A.     Farmer,     M.D.     (2nd),     103     Davis 

Street,  Fayetteville 
James   S.   Raper,  M.D.    (10th),  Doctors   Build- 
ing,  Asheville 
Jack    W.    Wilkerson,   M.D.    (4th),    Community 

Clinic,  Stantonsburg 

23.  Committee   to   Work   with    North    Carolina 
Industrial    Commission    (6)    II-6 

Thomas  B.  Dameron,  Jr.,  M.D.,  Chairman, 
1313  Daniels  Street,  Raleigh 

Wm.  F.  Hollister,  M.D.,  Moore  County  Hospi- 
tal, Pinehurst 

James  S.  Mitchener,  Jr.,  M.D.,  Scotland 
County  Memorial  Hospital,  Laurinburg 

Guv  L.   Odom,   M.D.,   Duke  Hospital,   Durham 

Malory  A.  Pittman,  M.D.,  Wilson  Clinic 
Wilson 

Charles  T.  Wilkinson,  M.D.,  205  Waite  Street, 
Wake  Forest 

24.  Committee  on  Insurances   (7)   IV-3 

Joseph  W.  Hooper,  Jr.,  M.D.,  Chairman,  110 
N.   11th   Street,   Wilmington 

Robert  H.  Brashear,  Jr.,  M.D.,  N.  C.  Mem- 
orial  Hospital,  Chapel   Hill 

John  C.  Burwell,  Jr.,  M.D.,  1026  Professional 
Village,  Greensboro 

Barry  F.  Hawkins,  M.D.,  Ardsley  Road,  Con- 
cord 

Alban  Papineau,  M.D.,  Plymouth  Clinic,  Ply- 
mouth 

Henry  B.  Perry,  Jr.,  M.D.,  344  North  Elm 
Street,   Greensboro 

S.  Glenn  Wilson,  M.D.,  Box  158,  Angier 

25.  Committee  on  Legislation  (3  members  plus 
President  &  Secretary)  10  Consultants)  V-2 
Hubert    McN.    Poteat,    Jr.,    M.D..    Chairman- 

(National),  713  Wilkins  Street,  Smithfield 
Lenox  D.  Baker,  M.D.,  Duke  Hospital,  Durham 
Edgar    T.    Beddingfield,   Jr.,    M.D.,    Co-Chair- 

man-( State),  P.  O.   137,  Stantonsburg 
Amos   N.   Johnson,   M.D.,   President    (Ex   Offi- 
cio), Garland 
John  S.  Rhodes,  M.D.,  Secretary   (Ex  Officio), 

700  W.   Morgan  Street,   Raleigh 
Daniel   S.   Currie,  Jr.,  M.D.   (Consultant),   111 

Bradford   Avenue,   Fayetteville 
Joseph      S.      Holbrook,      M.D.,      (Consultant), 

Davis  Hospital,  Statesville 
Wm.  E.  Keiter,   M.D.    (Consultant)    400  Glen- 
wood  Avenue,    Kinston 
Donald  B.   Koonce,  M.D.    (Consultant),  408  N. 

11th    Street,   Wilmington 
Leslie    M.    Morris,    M.D.    (Consultant),    Med- 

ica   Building,   Gastonia 
Zack   D.    Owens,    M.D.    (Consultant),    Medical 

Building,   Elizabeth   City 
Robert    Stuart   Roberson,    M.D.    (Consultant), 

102    Brown   Avenue,    Hazelwood 
James   P.   Rousseau,    M.D.    (Consultant)    1014 

West    Fifth    Street,    Winston-Salem 
Ben  F.   Royal,  M.D.    (Consultant),  907   Evans 

Street,  Morehead   City 
Thomas   B.  Dameron,  Jr.,   M.D.    (Consultant), 

1313   Daniels   Street,  Raleigh 
26.       Committee  on   Maternal   Health    (14)    VI-6 

James    F    Donnelly,    M.D.,    Chairman     (1966). 

State   Board   of*  Health,   Raleigh 
W.    Joseph    May,    M.D.,   Secretary    (8th),    121 

Professional    Bldg.,   Winston-Salem 


298 


NORTH  CAROLINA   MEDICAL  JOURNAL 


July.   1960 


Glenn     E.     Best,     M.D.,     (3rd)-(1966),     Main 

Street,    Clinton 
Jesse    Caldwell,    Jr.,    M.D.,    (7th)-(1961),    114 

West  Third   Street,   Gastonia 
P.    J.    McElrath,    M.D.    (6th)-(1961),    500    St. 

Mary's   Street,  Raleigh 
Milton'  S.   Clark,    M.D.     (4th)-(1961),    Wacho- 
via Bank  Bids'.,  Goldsboro 
W.   Otis   Duck,   M.D.    (10th)-(1963),   Box   387, 

Mars   Hill 
Wm.     A.    Hoggard,     Jr.,     M.D.     (lst)-(1965), 

1502   Carolina  Avenue.   Elizabeth   City 
Wm.  R.  Wellborn,  Jr.,  M.D.   (9th)-(1964),  222 

W.   Union   Street,   Morganton 
Frank    R.    Lock,    M.D.     (BG)-(1965),    300    S. 

Hawthorne    Road,   Winston-Salem 
Hugh  A.   McAllister,  M.D.    (5th)-(1965),   27th 

at  Barker  St.,  Lumberton 
Roy    T.     Parker,    M.D.     (Duke)-(1966),     Box 

3517,   Duke    Hospital,  Durham 
Robert    A.    Ross,    M.D.    (UNC)-(1963),    N.    C. 

Memorial  Hospital,  Chapel   Hill 
H.    Fleming    Fuller,   M.D.    (2nd)-(1963),    Kin- 

ston    Clinic,    Kinston 

27.        Medical-Legal   Committee   (7)    V-3 

Julius  A.  Howell,  M.D.,  Chairman,  Bowman 
Gray,  Winston-Salem 

Theodore  S.  Raiford.  M.D.,  301  Doctors 
Bldg.,   Asheville 

David  G.  Weiton,  M.D.,  403  N.  Tryon  Street, 
Charlotte 

John  W.  Foster,  M.D.,  Veterans  Administra- 
tion,   Winston-Salem 

Connell  G.  Garrenton,  M.D..  Bethel  Clinic, 
Bethel 

June  U.  Gunter,  M.D.,  Watts  Hospital,  Dur- 
ham 

Bennette  B.  Pool,  M.D.,  414  Nissen  Building, 
Winston-Salem 

2S         Committee   on   Medical    Care   Armed    Forces 
Dependents    ("MEDICARE")    (13)    (plus 
Subcommittee    Consultants — 19)    II-7 

David   M.   Cogdell,   M.D.,   Chairman.   911    Hay 

Street,   Fayetteville 
George    A.    Watson,    M.D.,    306    S.     Gregson 

Street,   Durham 
Wm.     H.     Breeden,     M.D.,     1606     Morganton 

Road,    Favetteville 
Everett  I.  Bugg,  Jr.,  M.D.,  Broad  and  Engle- 

wojd   Sts.,   Durham 
Jesse     Caldwell,    Jr.,     M.D..     114     W.     Third 

Street,  Gastonia 
Daniel     S.     Currie,    Jr.,     M.D.,     111     Bradford 

Avenue,   Favetteville 
Powell     G.     Fox,     M.D.,     1110    Wake     Forest 
Road,  Raleigh 

Wm.   F.    Hollister,    M.D.,    Moore    County   Hos- 
pital,  Pinehurst 
Donald   B.  Koonce,   M.D.,   408  N.   11th   Street, 

Wilmington 
J.   Douglas   McRee,   M.D.,  2109   Clark  Avenue, 

Raleigh 
Vernon  L.  Andrews,  M.D.,  Box  407,  Mt.  Gilead 
A.    Ledyard    DeCamp,    M.D.,    1505    Elizabeth 

Avenue,   Charlotte 
Donald   H.  Vollmer,   M.D.,  403   Doctors   Bldg., 

Asheville 
A. — General   Medicine 

John  L.   McCain,   M.D.,  Chairman,  Wilson 

Clinic,  Wilson 
B.    Joseph    Christian,    M.D.,    948    Walker 

Avenue,    Greensboro 
Leonard  E.  Fields,  M.D.,  Box  788,  Chapel 

Hill 
Joseph    M.    Hitch,    M.D.,    415   Professional 
Bldg.,   Raleigh 


B. — Radiology 

James     E.     Hemphill,      M.D.,     Chairman, 
1012   Kings  Drive,   Charlotte 

Joe     Lee     Frank,     Jr.,     M.D..     Roanoke- 
Chowan   Hospital,  Ahoskie 
C. — Surgery 

Wayne    H.     Stockdale,     M.D.,    Chairman, 
703   North    Street,   Smithfield 

Howard    M.   Ausherman,    M.D.,    200   Haw- 
thorne  Lane,   Charlotte 

Fred    K.    Garvey,    M.D.,    Bowman    Gray, 
Winston-Salem 

George  R.  Miller,  M.D.,  412  Realty  Bldg., 
Gastonia 

Guy  L.  Odom,   M.D..  Duke  Hospital,  Dur- 
ham 

C.  F.  Siewers,  M.D.,  201  Churchill  Drive, 
Favetteville 

Larry     Turner,      M.D.,      1110      W.      Main 
Street,   Durham 
D. — Obstetrics    &    Gynecology 

John    C.    Burwell,    Jr.,     M.D.,    Chairman, 
1026    Professional    Village,    Greensboro 

R.   Vernon   Jeter,    M.D.,   Plymouth   Clinic, 
Plymouth 

Trogler  F.  Adkins,   M.D.,  306  S.  Gregson 
Street,    Durham 
E. — Pediatrics 

Dan  P.  Boyette,  Jr.,  M.D.,  Chairman,  217 
W.   Main  Street,   Ahoskie 

Robert  F.  Poole,  Jr.,   M.D.,  817   Hillsboro 
Street,    Raleigh 

George  W.  Kernodle.   M.D.,   Medical   Cen- 
ter  Pharmacy    Bldg.,    Burlington 

29.  Committee  on  Menial  Health   (14)   VI-7 
Allyn  B.  Choate,  M.D.,  Chairman,   1012   Kings 

Drive,   Charlotte 

Wilmer  C.  Betts,  Jr.,  M.D.,  2109  Clark  Ave- 
nue, Raleigh 

E.    W.    Busse,    M.D.,   Duke    Hospital,    Durham 

Milton  S.  Clark,  M.D.,  Wachovia  Bank  Bldg., 
Goldsboro 

James  F.  Elliott,  M.D.,  State  Hospital,  But- 
ner 

John  W.  Ervin,  M.D.,  Box  132,  State  Hos- 
pital,   Morganton 

John  A.  Fowler,  M.D.,  2212  Erwin  Road, 
Durham 

Thomas  T.  Jones,  M.D.,  604  W.  Chapel  Hill 
Street,   Durham 

Hans  Lowenbach,  M.D.,  Duke  Hospital,  Dur- 
ham 

Phillip  G.  Nelson,  M.D.,  1211  Rock  Spring 
Road,   Greenville 

James  T.  Proctor,  M.D.,  428  Ridgefield  Road, 
Chapel   Hill 

Walter  A.  Sikes,  M.D.,  State  Hospital,  Ral- 
eigh 

Joseph  B.  Stevens,  M.D.,  1017  Professional 
Village,   Greensboro 

David  A.  Young,  M.D.,  714  St.  Mary's  Street, 
Raleigh 

30.  Committee  on  Necrology   (3)   IV-4 

Charles  H.   Pugh,    M.D.,   Chairman,   Box   527, 

Gastonia 
Charles     T.    Pace,    M.D.,    Co-Chairman,     1802 

Independence,  Greensboro 
Ben  F.  Royal,   M.D.,  Box   628,   Morehead   City 

31.  Committee  on  Negotiations   (3)    IX-0 

Wm.   F.   Hollister,   M.D..  Chairman    (term   ex- 
pires  1961),   Moore    County   Hospital,   Pine- 
hurst 
Theodore     S.     Raiford,     M.D.     (term     expires 

1963),  301   Doctors   Bldg.,   Asheville 
Hubert    McN.    Poteat,    Jr.,    M.D.     (term    ex- 
pires    1965),    713     Wilkins     Street,     Smith- 
field 


1960 


SCHEDULE  OF  COMMITTEE  APPOINTMENTS 


299 


35. 


Chairman    (9th)     7 
W.,   Hickory 
(7th),  114  W.  Third 


913   Murchison 
Davis 


140   S.   W. 

Bow- 

Build- 

Green- 

Wilson 

Doctors 


32.       Nominating   Committee 

Jacob    H.    Shuford,   M.D., 
Main   Avenue  Place,    S. 
Jesse  Caldwell,  Jr.,  M.D. 

Street,   Gastonia 
Robert  M.   Fales,   M.D.    (3rd). 

Bldg.,  Wilmington 
Paul    F.    Maness,    M.D.    (6th),    328    W. 

Street,   Burlington 
Robert   M.    McMillan,    M.D.    (5th), 

Broad   Street,    Southern   Pines 
Charles    M.    Norfleet,    Jr.,    M.D.    (8th) 

man   Gray,    Winston-Salem 
Zack   D.    Owens,    M.D.    (1st),    Medical 

ing,  Elizabeth  City 
Karl    B.    Pace,    M.D.    (2nd),    Box   620, 

ville 
Malory     A.      Pittman,      M.D.     (4th), 

Clinic,   Wilson 
James    S.    Raper,    M.D.    (10th),    103 
Bldg.,    Asheville 
33.       Committee  of  Physicians  on  Nursing  (8)   IV-5 
Robert    R.    Cadmus,    M.D.,    Chairman,    N.    C. 

Memorial  Hospital,   Chapel  Hill 
Harry     L.     Brockmann,     M.D.,     624     Quaker 

Lane,   High   Point 
Badie  T.   Clark,   M.D.,   Carolina  General   Hos- 
pital, Wilson 
James    E.    Davis,    M.D.,    1200    Broad    Street, 

Durham 
Wm.   D.  James,  Jr.,   M.D.,   Box   351,   Hamlet 
David  T.  Smith,  M.D.,  Duke  Hospital,  Durham 
Thomas   J.    Taylor,    M.D..   643    Roanoke    Ave- 
nue, Roanoke   Rapids 
Nursing   and    Nursing    Education — Subcom- 
mittee 

Thomas  J.   Taylor,   M.D.,   Chairman,   643   Ro- 
anoke Avenue,  Roanoke  Rapids 
Nursing   Careers-Subcommittee 
Andrew   J.    Crutchfield,    M.D.,    Chairman,    610 

W.   Fifth   Street,   Winston-Salem 
Improvement  of  the   Care   of  the   Patient- 
Subcommittee 
Harry    L.    Brockmann,    M.D.,    Chairman,    624 

Quaker  Lane,   High   Point 
David  T.  Smith,  M.D.,  Duke  Hospital,  Durham 

34.       Committee    on    Occupational    Health    (9)    VI-8 

Harry     L.     Johnson,     M.D.,     Chairman,     Box 


530,  Elkin 
B.    F.    Cozart 

Reidsville 
B.   Joseph   Christian 

nue,   Greensboro 
Mac  Roy  Gasque,   M.D.,  Pisgah  Forest 
W.    B.   Townsend,    M.D.,    Box  420,    Charlotte 
T.    Beddingfield,   Jr.,    M.D., 
Stantonsburg 


M.D.,     1116     S.    Main     Street, 
M.D.,   948   Walker   Ave- 


P.   O.    Box 


M.D.,     307     Woodburn 


M.D.,  N.  C 
Chapel  Hill 
M.D 


Memorial 


Edgar 

137, 
James     Kent    Rhodes, 

Rd.,   Raleigh 
Wm.   P.    Richardson, 

Hospital.   Box   758, 
Logan     T.     Robertson, 

Street,    Asheville 

Committee    on    Postgraduate 
(8)  IV-6 

Samuel  L.  Parker,  Jr.,   M.D... 

ston  Clinic,   Kinston 
Wayne    J.    Benton,    M.D..    2320 

Rd.,  Greensboro 
Richard    C.     Proctor,     M.D.,     Bowman     Gray, 

Winston-Salem 
W.  Otis  Duck,  M.D.,   Box  387,  Mars   Hill 
Joseph    A.    Isenhower,    M.D.,    17    2nd    Avenue, 

N.   E.,   Hickory 
Wm.    McN.    Nicholson,    M.D.,    Duke   Hospital, 

Durham 


17      Charlotte 

Medical    Study 

Chairman,  Kin- 
Battleground 


36. 


37 


Frank   R.   Reynolds,   M.D.,   1613    Dock    Street, 
Wilmington  „     „     ,,  .   , 

Wm.    P.    Richardson,    M.D.,    N.    C.    Memorial 
Hospital,   Chapel  Hill 

Committee   on    Poliomyelitis    (14)    VI-9 

Samuel   F.    Raveuel,    M.D.,   Chairman,    104    t. 
Northwood   Street,   Greensboro 

Jay    M.   Arena,    M.D.,   1410    Duke    University 
Road,  Durham  ,   _    ..     ., 

Edward   P.  Benbow,  Jr.,   M.D.,   104    E.   North- 
wood   Street,  Greensboro 

John   W.   Varner,   M.D.,    Box   522,   Lexington 
Charles   R.   Bugg,   M.D.,   627   W.   Jones   Street, 

Ralp^ B.  Garrison,  M.D.,  222   N.   Main  Street, 

Hamlet  . 

Wm.    F.    Harrell,    Jr.,    M.D.,    Guaranty    Bank 

Bldg.,    Elizabeth   City 
Richard     S.     Kelly,     M.D.,     1606     Morganton 

Road,   Fayetteville 
Donald   B.   Koonce,   M.D.,  408  N.   11th   Street, 

Wilmington  _r„ 

Robert  C.   Pope,   M.D.,   Wilson   Clinic.   Wilson 
Fiank  H.  Richardson,   M.D.,  Children's   Clinic, 

Black    Mountain 

Box  BB,  Marshall 
M.D.,  301  W.  End  Ave- 


38. 


M.D,     Halifax     County 
Halifax 
Relations    (3)     (7    Dis- 


M.D.,  Chairman, 
137,  Stantonsburg 
(5th)    (1961),    222 


Wm.  A.  Sams,  M.D., 
Wm.  G.  Spencer.  Jr., 

nue,  Wilson 
Robert     F.     Young, 

Health  Department, 

Committee    on    Public 
trict   Consultants)    V-4 

Edgar   T.    Beddingfield,   Jr. 

(4th)    (1962),  P.  O.   Box 
Ralph    B.    Garrison,    M.D. 

N.   Main  Street,  Hamlet 
Courtney  D.  Egerton,  M.D.   (6th)    (1963),  714 

St.  Mary's  Street,  Raleigh 
Stephen  R.  Bartlett,  Jr.,  M.D.    (2nd)    (consul- 
tant), 1001    E.    4th    Street,   Greenville 
Glenn     E.     Best,     M.D.,     (3rd)      (consultant), 

Main  Street,   Clinton 
Wm.    H.    Bureh,    M.D.,     (10th)     (consultant), 

Valley  Clinic  &  Hospital,  Bat  Cave 
Joseph  S.  Holbrook,  M.D.,   (9th)    (consultant). 

Davis  Hospital,   Statesville 
Fred    K.    Garvey,    M.D.     (8th)     (consultant), 

Bowman   Grav,   Winston-Salem 
Walter   Spaeth,    M.D.    (1st)    (consultant),    116 

South   Road   Street,   Elizabeth   City 
David    G.    Welton,    M.D.     (7th)     (consultant), 

403   N.  Tryon  Street,  Charlotte 
Committee   on    Physical    Rehabilitation     (8) 

George     W.     Holmes,     M.D.,     Chairman,     2240 
Cloverdale    Avenue,    Winston-Salem 
Charles  H.  Ashford,  M.D.,  603  Pollock  Street, 

New   Bern 
F    P.  Dale,  M.D.,  Kinston  Clinic,  Kinston 
J.     Leonard     Goldner,     M.D.,     Duke    Hospital, 


M.D- 


1313     Daniels 
N. 
M.D.,    123    N. 
M.D.,     405 


Center 
Second 
Colony 


39. 


Durham 
Walter     S.     Hunt, 

Street,  Raleigh 
John     Hays     Rosser.     M.D.,     222 

Street,    Statesville 
Marion    B.    Pate,    Ji  . 

Street,  St.  Pauls 
George     H.     Wadsworth, 

Avenue,  Ahoskie 
Committee   on    Rural    Health    and    General 
Practitioner   Award    (9)    V-5 
R.   Vernon   Jeter,    M.D.,    Chairman,   Plymouth 

Clinic,   Plymouth 
Philip   E.  Dewees,   M.D.,   Box   217,   Sylva 
Vernon   W     Taylor,   Jr.,   M.D.,   815   N.   Bridge 

St.,   Elkin 


.••Slid 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July.    1960 


J.  O.  Williams.  M.D.,  Cabarrus  County  Hos- 
pital,  Concord 

George  T.  Wolff,  M.D.,  135  Bishop  Street, 
Greensboro 

Charles  T.  Wilkinson.  M.D.,  209  Wilkinson 
Bldf?.,   Wake   Forest 

Edward    L.    Bovette,    M.D  ,    Kenansville 

W.  E.  Swain,  M.D.,  201  E.  5th  Street,  Wash- 
ington 

John  T.   Dees,   M.D.,   Box   248,   Burgaw 

10.  Committee   on    School    Health    and    State 
Coordinating   Service   (9)   VI-11 

Irma    C.    Henderson    Smathers,    M.D.,    Chair- 
man,    1295     Merrimon    Avenue,    AsheviUe 
Bruce  B.   Blackmon,   M.D.,  Buies   Creek 
Jean  Davidson  Craven,  M.D.,  19  W.   3rd  Ave- 
nue,  Lexington 
Charles     H.     Gay,    M.D.,     1012     Kings     Drive, 

Charlotte    7 
Wm.   C.   Hunter,   M.D.,   103   Pine   Street,   Wil- 
son 
Floyd    L.    Knight.    M.D  ,    103    Hillcrest   Drive, 

Sanford 
Joseph  S.   Bower,   M.D.,   Box   12,   Pink  Hill 
Robert   C.   Pope,   M.D.,   Wilson   Clinic,   Wilson 
Wm.    T.   Rainey,    Si\,    M.D.,    Highsmith    Hos- 
pital,   Fayetteville 

11.  Committee    Advisory    to   Student    A.M. A. 
Chapters   in   North   Carolina   (8)    II-8 

John    P.    Davis,    M.D.,    Chairman,    821    Nissen 

Bldg.,   Winston-Salem 
Edgar   T.    Beddingfield,   Jr.,    M.D.,    P.   O.    Box 

137,   Stantonsburg 
Charles   G.    Young,   M.D.,    135    Bishop    Street, 

Greensboro 
Isaac  E.  Harris,  Jr.,  M.D.,  1200  Broad  Street, 

Durham 
John    W.   Nance,    M.D.,    Main    Street,   Clinton 
Robert  A.   Ross,   M.D.    (UNC   Consultant),   N. 

C.   Memorial   Hospital,   Chapel   Hill 
Wm.    P.    J.   Peete,    M.D.    (Duke    Consultant), 

Duke   Hospital,    Durham 
Robert   L.    McMillan,   M.D.    (BG    Consultant), 

Bowman   Gray,    Winston-Salem 

42.  Committee   on   Veterans  Affairs    (9)    VI-12 
Samuel     L.     Elfmon,     M.D.,     Chairman,     225 

Green   Street,  Fayetteville 
Vernon   L.    Andrews,    M.D.,    Box    407    Mt.   Gi- 

lead 
Wilmer    C.    Betts,    M.D.,    2109    Clark   Avenue, 

Raleigh 
H.    Francis    Forsyth,     M.D.,    Bowman    Gray, 

Winston-Salem 
David    L.    Phillips,    M.D.,     110    Oak    Avenue, 

Spruce   Pine 
James    D.    Piver,    M.D.,    209    Bayshore    Blvd., 

Jacksonville 
R.  W.   Postlethwait,  M.D.,   VA   Hospital,   Dur- 
ham 
John   T.    Session^   Jr.,    M.D..    UNC    Dapt.    ot 

Medicine,    Chapel    Hill 
Charles   R.  Welfare,  M.D.,  Professional   3idg., 

Winston-Salem 

43.  Insurc-nce    Industrv     Liaison    Committee 
(10)   V-f 

Frank  W.  Jones,  M.D.,  Chairman,  Catawba 
Hospital,   Newton 

Jack  E.  Mohr,  M.D.,  Acting  Chairman,  Med- 
ical   Arts   Building,    Lumberton 

Grover  C.  Bolin,  Jr.,  M.D.,  Box  120,  Smith- 
field 

Andrew  J.  Dickerson,  M.D.,  1600  N.  Main 
Street,   Waynesville 

Archie  Y.  Eagles,  M.D.,  407  Colony  Avenue, 
Ahoskie 

Cleon  W.  Goodwin.  M.D.,  Wilson  Clinic,  Wil- 
son 


Charles  I.  Harris,  Jr.,  M.D.,  Martin  General 
Hospital,    Williamston 

Barry  F.  Hawkins,  M.D.,  Ardsley  Road,  Con- 
cord 

James  R.  Wright,  M.D.,  604  Professional 
Bldg.,   Raleigh 

George  T.  Wolff,  M.D.,  135  Bishop  Street, 
Greensboro 

II.        Committee   Liaison   to   Study    Integration   of 
Negro    Physicians    into    Medici    Society    of 
State  of  North  Carolina    (7)    1-2 
J.   Street  Brewer,  M.D.,  Chairman,   P.   O.   Box 

98,   Roseboro 
Paul     F.     Whitaker,     M.D.,     1205     N.     Queen 

Street,   Kinston 
Ben     F.     Royal,    M.D.,     900     Shepherd    Street, 

Morehead    City 
James    P.    Rousseau,    M.D.,    1014    West    Fifth 

Street,   Winston-Salem 
Joseph    W.    Hooper,    Jr.,    M.D.,    410    N.    11th 

Street,    Wilmington 
James   E.   Hemphill,   M.D.,   1012   Kings    Drive, 

Charlotte    7 
Henry    B.    Perry,    Jr.,    M.D.,    344    North    Elm 

Street,    Greensboro 


BULLETIN  BOARD 


COMING  MEETINGS 

North  Carolina  Urological  Association,  Annual 
Meeting — Greystone  Inn,  Roaring  Gap,  September 
25-26. 

North  Carolina  Fifth  District  Medical  Society 
Meeting — Mid  Pines  Club,  Pinehurst,  October  5. 

Eleventh  Annual  Winston-Salem  Heart  Sympo- 
sium— Robert  E.  Lee  Hotel,  Winston-Salem,  Octo- 
ber 7. 

Congress  on  Industrial  Health — Hotel  Charlotte, 
Charlotte,  October   10-12. 

Duke  University  Medical  Postgraduate  Seminar 
Cruise   to   the   West    Indies — November  9-18. 

North  Carolina  Academy  of  General  Practice, 
Annual  Meeting — Carolina  Hotel,  Pinehurst,  No- 
vember 27-30. 

Fifth  International  Congress  on  Nutrition — 
Sheraton  Park  and  Shoreham  Hotels,  Washington, 
D.C.,   September   1-7. 

Southern  Trudeau  Society  and  Southern  Tuber- 
culosis Society  Meeting — Hotel  Francis  Marion, 
Charleston,   South   Carolina,   Saptember   14-16. 

American   Rhinologic  Society,  Sixth   Annual  Aleet- 

ing — Belmont   Hotel,   Chicago,  October   8. 

American  College  of  Surgeons,  Forty-sixth  An- 
nual Clinical  Congress — San  Francisco,  October 
10-14. 

Inter-state  Post-graduate  Association,  Forty- 
fifth  Scientific  Assembly — Pittsburgh,  October  31- 
November  3. 


Julv,   1960 


BULLETIN  BOARD 


301 


News  Notes  from  the  Duke  University 
Medical  Center 

A  Duke  University  medical  postgraduate  sem- 
inar cruise  to  the  Virgin  Islands  and  Puerto  Rico 
has  been  scheduled  for  next  November. 

Plans  for  the  cruise  were  announced  by  Dr. 
William  M.  Nicholson,  assistant  dean  of  the  Duke 
Medical  School  in  charge  of  postgraduate  educa- 
tion. This  cruise  will  replace  one  which  has  been 
scheduled  for  the  Baltic  area  in  June  and  which 
was   cancelled,   Dr.   Nicholson   said. 

Purpose  of  the  medical  cruises  is  to  enable  phy- 
sicians to  combine  postgraduate  education  with 
vacation  travel.  Lectures  by  Duke  Medical  Center 
faculty  members  are  given  aboard  ship  during 
the  cruises. 

Physicians  participating  in  the  Virgin  Islands 
cruise  will  sail  from  New  York  aboard  the  Swed- 
ish American  Motorlines  Kungsholm  on  November 
9.  Stops  will  be  made  at  St.  John  and  St.  Thomas 
in  the  Virgin  Islands  and  at  San  Juan,  Puerto 
Rico.  The  cruise  will  terminate  at  New  York  on 
November  18. 

Serving  on  the  shipboard  faculty  will  be  Dr. 
Edwin  P.  Alyea,  professor  of  urology;  Dr.  Nichol- 
son, professor  of  medicine;  Dr.  Elbert  L.  Persons, 
professor  of  medicine;  Dr.  William  W.  Shingleton, 
professor  of  surgery;  and  Dr.  Doris  A.  Howell, 
associate  professor  of  pediatrics. 

The  lectures  will  deal  with  subjects  that  include 
thyroid  abnormalities,  chemical  treatment  of  can- 
cer, arthritis,  diabetes,  and  blood  disease.  The  pro- 
gram will  provide  30  hours  of  Category  I,  Post- 
graduate Education,  required  by  the  American 
Academy  of  General  Practice. 

Information  concerning  the  cruise  may  be  ob- 
tained by  writing  to  the  Director  of  Postgraduate 
Education,  Duke  University  Medical  Center,  Dur- 
ham,   North    Carolina. 

*     *     * 

A  study  aimed  at  the  establishment  of  an  In- 
stitute on  Continued  Patient  Care  has  been 
launched  at  the  Duke  University   Medical  Center. 

Currently  being  evaluated  by  State  public  health 
officials,  welfare  leaders  and  others,  the  proposed 
institute  would  provide  an  educational  program 
for  workers  in  various  health  fields.  Purpose  of 
the  program  would  be  to  mobilize  and  coordinate 
health  services  that  are  available  to  patients  after 
their  discharge  from   hospitals. 

David  P.  Henry,  Duke  Medical  Center  rehabili- 
tation coordinator  who  presided  at  a  meeting  held 
here  to  discuss  the  possibility  of  such  a  program, 
said  that  hospital  patients  are  often  unable  to  re- 
turn home  when  their  condition  permits  discharge 
simply  because  no  resources  are  readily  available 
for  the  special  home  care  that  is  required  for 
them. 

In  addition  to  local  physicians,  health  personnel 
such  as  nurses,  physical  therapists,  welfare  workers 
and    vocational    rehabilitation    counselors    play   im- 


portant roles  in  the  home  care  of  a  patient  after 
he  leaves  the  hospital,  Henry  stated.  Also,  im- 
portant contributions  in  this  area  can  be  made  by 
voluntary  groups  such  as  ministers  civic  clubs  and 
women's  clubs,  he  said.  A  coordinated  follow-up 
program  with  clear-cut  areas  of  responsibility 
would  enable  all  these  groups  and  persons  to 
function   effectively   as   a   team. 

Among  persons  attending  the  Duke  meeting, 
which  was  held  to  study  the  problem  of  follow- 
up  care  and  to  obtain  all  possible  information  for 
evaluation,  were:  Dr.  Roy  Norton,  head  of  the 
N.  C.  Department  of  Public  Health;  Dr.  Ellen 
Winston,  head  of  the  N.  C.  Department  of  Public 
Welfare;  Dr.  Amos  Johnson  of  Garland,  president 
of  the  N.  C.  Medical  Society;  William  N.  Ruffin  of 
Durham,  former  president  of  the  National  Assn. 
of  Manufacturers;  Col.  Charles  Warren,  director  of 
the  N.  C.  Office  of  Vocational  Rehabilitation;  Dean 
Edward  McGavin  of  the  University  of  North  Car- 
olina School  of  Public  Health;  Dr.  David  Garvin 
of  Chapel  Hill,  director  of  the  Orange-Person- 
Chatham  County  Health  District;  Dr.  James  H. 
Semans,  chairman  of  the  Duke  Medical  Center's 
rehabilitation  committee;  F.  Ross  Porter,  director 
of  the  Duke  Medical  Center  Foundation;  and  Duke 
Hospital   superintendent    Charles   H.    Frenzel. 

Dean  W.  C.  Davison  of  the  Duke  Medical  School 
pointed  out  that  in  addition  to  lightening  the  cost 
of  hospital  care  by  permitting  earlier  discharges 
of  many  patients,  this  program  could  make  possi- 
ble better   care   of  the    aged    and   chronically   ill    as 

well  as  the  patient  just  home  from  the  hospital. 
$     *     $ 

The  retiring  dean  of  the  Duke  University  School 
of  Medicine,  Dr.  W.  C.  Davison,  has  been  elected 
president  of  Alpha  Omega  Alpha,  national  Honor 
Medical   Society. 

Dr.  Davison,  who  retired  as  dean  of  the  Duke 
Medical  School  on  July  1,  will  retire  from  the  fac- 
ulty in  August,  1961.  During  his  final  year  he 
will  continue  as  James  B.  Duke  Professor  of  Pedi- 
atrics. 

In  electing  Dr.  Davison  to  head  the  national 
37,000-member  body,  the  members  of  Alpha  Omega 
Alpha  placed  the  Duke  dean  among  a  select  group 
of  only  five  other  persons  who  have  been  presi- 
dent of  the  society  during  its  58-year  history. 

Dr.  Davison,  a  member  of  the  board  of  directors, 
succeeds  Dr.  Walter  Lawrence  Bierring  of  Des 
Moines,  Iowa. 

Other  Alpha  Omega  Alpha  officers  include 
Willard  C.  Rappleye  of  New  York,  vice-president; 
and  Josiah  J.  Moore  of  Chicago,  secretary- 
treasurer,  both  re-elected;  and  James  A.  Campbell, 
who   was   named    secretary-treasurer-elect. 

How  did  the  first  man  get  to  North  America  ? 

In  an  attempt  to  solve  the  ancient  riddle,  a  Duke 
University  research  project  has  been  launched 
under  the  direction  of  Dr.  Daniel  A.  Livingstone 
of    the     Zoology    Department     faculty.     A     $25,600 


302 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July,    1960 


grant  from  the  National  Science  Foundation  will 
support  the  work  over  the  next  two  years. 

Paul  Colinvaux,  Duke  graduate  student  who  is 
assisting  Dr.  Livingstone,  has  just  arrived  in  Alas- 
ka. He  will  make  care  drillings  to  extract  ma- 
terials from  land  under  the  lakes. 

After  the  materials  are  obtained,  they  will  be 
brought  to  Duke  where  they  will  be  examined  for 
plant  and  animal  microfossils,  as  well  as  for  chem- 
ical indications  of  past  environment.  Radioisotopic 
techniques  will  be  used. 

The  Duke  researchers  hope  to  find  out  whether 
climatic  conditions  were  the  type  which  could  have 
allowed  man  to  cross   to  this  continent. 


A  new  infant  formula  laboratory  where  some 
800  baby  bottles  are  prepared  each  day  under 
sterile  conditions  as  exacting  as  those  of  an  oper- 
ating room  has  been  open  opened  at  Duke  Hospi- 
tal. The  $45,000  facility  replaces  the  previous 
formula   laboratory    and   is  four    times    as    large. 

Mrs.  A.  H.  Hampton,  head  nurse  in  the  labora- 
tory, said  that  the  unit  provides  formula  for  in- 
fants in  the  premature  and  newborn  nurseries  and 
for  those  on  medical  and  surgical  wards.  As  many 
as  25  different  kinds  and  strengths  of  formula  are 
made   up   daily   according  to   doctors'   specifications. 

Dr.  Angus  McBryde,  professor  of  pediatrics,  was 
instrumental  in  planning  the  laboratory,  which  is 
among  the  latest  of  a  number  of  renovation  pro- 
jects at  the  Duke  Medical  Center. 


News  Notes  from  the  University  of 
North  Carolina  School  of  Medicine 

Awards  and  honors  were  announced  by  the  Uni- 
versity of  North  Carolina  School  of  Medicine  at 
special  exercises  in  honor  of  the  69  members  of  the 
graduating   class. 

Dr.  W.  Reece  Berryhill,  dean  of  the  school,  pre- 
sided over  the  program  and  Dr.  Nathan  Womack, 
head  of  the  Department  of  Surgery,  was  the  prin- 
cipal speaker.  A  brief  address  also  was  given  by 
James  R.  Harper  of  Chapel  Hill,  president  of  the 
graduating  class. 

The  American  Medical  Women's  Association 
Scholastic  Award  went  to  Margaret  B.  Scales  of 
Bay  Shore,  New  York. 

Robert  B.  Payne  of  Gastonia  received  the  Deb- 
orah C.   Leary   Memorial  Award. 

The  Isaac  H.  Manning  Award  was  presented  to 
Carwile   LeRoy  of  Elizabeth   City. 

The  Mosby  Book  Awards  were  received  by  Ro- 
bert J.  Cowan,  Greensboro;  Frederick  D.  Hamrick 
III,  Rutherfordton;  Zebulon  Weaver,  III,  Asheville; 
Charles  P.  Eldridge,  Jr.,  Raleigh  and  James  R. 
Harper  of  Chapel   Hill. 

The  Roche  Award  went  to  William  L.  Black  of 
Charlotte. 

Kenneth  F.  McCain  of  High  Point  and  Carwile 
LeRoy  of    Elizabeth    City   were    given    the    Sheard- 


Sanford  Prizes  of  the  American  Society  of  Clin- 
ical  Pathologists. 

The  senior  papers  of  11  students  were  cited  as 
excellent  and  have  been  bound  and  placed  in  the 
U.N.C.   Division   of   Health    Affairs   Library. 

These  papers  were  written  by  William  L.  Black, 
Charlotte;  John  R.  Curtis,  Bessemer  City;  Gerald 
W.  Fernald,  Wilson;  Carwile  LeRoy.  Elizabeth 
City;  Kenneth  F.  McCain,  High  Point;  James  M. 
Marlowe,  Walstonburg;  William  N.  Mical,  Cincin- 
nati; Elwood  E.  Morgan,  Burlington;  Robert  B. 
Payne,  Gastonia;  William  S.  Pearson,  Statesville, 
and  John   C.  Tayloe,  Jr.,   of  Washington. 

A  total  of  17  other  senior  papers  were  cited  as 
being   outstanding. 

*  *     * 

A  number  of  faculty  members  of  the  University 
of  North  Carolina  School  of  Medicine  participated 
in  the  annual  meeting  of  the  American  Medical 
Association  in   Miami  in  June. 

Drs.  Richard  L.  Dobson  and  Donald  C.  Abelc  of 
the  Department  of  Medicine,  and  D.  M.  Hale,  a 
research  laboratory  supervisor,  presented  a  paper 
on  "The  Effect  of  High  and  Low  Salt  Intake  and 
Repeated  Episodes  of  Sweating  on  the  Human 
Endocrine   Sweat  Gland." 

Dr.  Charles  H.  Burnett,  head  of  the  Department 
of  Medicine,  serves  on  the  executive  committee  of 
the  Section  of  Experimental  Medicine  and  Ther- 
apeutics. 

Drs.  W.  H.  Akeson  and  D.  S.  Kellam  prepared 
an  exhibit  entitled  "Congenital  Kyphosis:  The 
Genesis  of  Microspondyly."  Dr.  Akeson  is  assistant 
professor  of  surgery  and  Dr.  Kellam  is  a  former 
resident  in  orthopedic  surgery  at  N.  C.  Memorial 
Hospital  and  is  now  with  the  Charlotte  Memorial 
Hospital. 

*  *     * 

The  Home  Savings  and  Loan  Association  of  Dur- 
ham and  Chapel  Hill  has  established  scholarships 
at  the  University  of  North  Carolina  School  of 
Medicine  which  will  amount  to  $1,000  annually  by 
1963. 

The  first  scholarship,  for  $250,  will  be  awarded 
to  a  first  year  medical  student  this  fall  and  is  re- 
newable for  the  entire  four  years  of  medical  study. 
A  similar  award  will  be  made  each  year  to  a  stu- 
dent of  the  incoming-  class  of  the  School  of  Medi- 
cine. By  1963  four  students  will  be  receiving  a 
total   of  $1,000   annually. 

The  selection  of  the  students  for  these  scholar- 
ships and  the  conditions  of  satisfactory  perform- 
ance necessary  for  annual  renewal  of  them  will  be 
determinsd   by   the   School    of   Medicine. 

In  announcing  the  scholarship.  Dr.  William  L. 
Fleming,  assistant  dean  of  the  School  of  Medicine, 
explained  that  scholarships  for  medical  schools 
were  of  particular  importance  at  the  present  time, 
in  view  of  the  increasing  need  of  physicians  to 
keep  pace  with  the  population  growth  of  the  na- 
tion. 


July,   1960 


NORTH  CAROLINA  MEDICAL  JOURNAL 


303 


Dr.  Fleming  said  that  the  duration  and  cost  of 
medical  training  was  much  higher  than  in  other 
professional  fields,  making  scholarships  more 
needed. 

Dr.  Colin  G.  Thomas,  Jr.,  of  the  Department  of 
Surgery  and  Dr.  John  T.  Sessions  of  the  Depart- 
ment of  Medicine  spoke  before  the  annual  meeting 
of  the  Seaboard  Medical  Association  at  Nags  Head 
recently.  Dr.  Thomas  talked  on  "The  Timing  and 
Selection  of  Surgical  Procedures  in  the  Manage- 
ment of  Pancreatitis,"  and  Dr.  Sessions  discussed 
the  topic,  "Does  Alcohol  Damage  the  Liver  When 
Taken  Before,  After  or  Instead  of  Meals." 

Dr.  Ernest  H.  Wood,  professor  of  radiology, 
was  elected  vice  president  of  the  American  Board 
of  Radiology  at  its  annual  trustee  meeting  in  Cin- 
cinnati. He  has  been  a  trustee  of  the  board  for 
several    years. 

$     *     * 

A  student  of  the  University  of  North  Carolina 
School  of  Medicine  will  spend  this  summer  work- 
ing in  a  small,  remote  hospital  in  the  Philippine 
Islands. 

Colonel  D.  Bessinger,  Jr.,  of  Asheville,  who  will 
graduate  from  the  U.N.C.  School  of  Medicine  next 
June  will  spend  the  summer  working  in  a  small 
remote  hospital  in  the  Philippines.  His  work  will 
be  under  the  sponsorship  of  the  Foreign  Mission 
Board  of  the  Southern  Baptist  Convention.  This 
project  is  made  possible  by  a  grant  of  $1,985  from 
the  Smith,  Kline  and  French  Foreign  Fellowship, 
which  is  administered  by  the  American  Associa- 
tion of  Medical  Colleges. 

Working  with  physicians  already  practicing  at 
Mati,  Bessinger  will  help  with  the  public  health 
program  and  at  the  same  time  gain  valuable  clin- 
ical experience.  In  addition,  he  will  serve  as  a 
"goodwill  ambassador"  representing  American 
medical  schools  in  bringing  the  latest  medical  tech- 
niques and  procedures  to  remote  hospitals  and 
clinics. 

*     *     * 

Dr.  Judson  J.  Van  Wyk,  associate  professor  of 
pediatrics  will  present  three  lectures  in  Europe 
during  June   and  July. 

He  will  speak  in  Switzerland,  England  and  Den- 
mark and  will  also  visit  various  endocrine  clinics 
in   France,   Germany  and   Holland. 

Dr.  Van  Wyk  will  address  the  Zurich  Kinder 
Klinik  in  Zurich,  Switzerland,  on  "Genetic  Factors 
in  Staple  Goiter." 

He  will  speak  before  the  Fourth  International 
Goiter  Congress,  which  meets  in  London  July  5-8. 
This  lecture  also  will  deal  with  the  inherited  as- 
pects of  goiter. 

Dr.  Van  Wyk  will  attend  the  First  International 
Endocrine  Congress  in  Copenhagen,  Denmark 
July   18-23.   Here   he   will   lecture   on   "Syndrome   of 


Precocious  Menstruation  and  Galactorrhea  in  Ju- 
venile Hypothyroidism:  An  Example  of  Hormonal 
Overlap  in  Pituitary  Feedback." 


Four  psychiatrists  of  the  staff  of  N.  C.  Mem- 
orial Hospital  of  the  University  of  North  Carolina 
have  been  cited  for  outstanding  theses  submitted 
in  connection  with  their  three-year  residency 
training  here. 

They  are  Dr.  J.  Iverson  Riddle,  Morganton;  Dr. 
Rex  Speers,  Claremont;  Dr.  George  Thrasher.  Ro- 
anoke, Virginia,  and  Dr.  Andrew  Briggs  of  Rich- 
mond. 

Dr.  Riddle  took  first  place  and  Dr.  Speers  was 
awarded  second  place  for  the  Anclote  Manor  Hos- 
pital Prize.  These  awards  were  $150  and  $50. 

The  title  of  Dr.  Riddle's  thesis  was  "Mental  Sub- 
normality:  Its  Place  in  Psychiatric  Residency 
Training  Program."  Dr.  Speers'  thesis  was  "Brief 
Psychotherapy  with  College  Women — Technique 
and   Criteria  for  Selection." 

Dr.  Thrasher  and  Dr.  Briggs  received  honorable 
mention  for  their  theses. 

The  medical  director  of  Anclote  Manor  Hospital 
at  Tarpon  Springs,  Florida,  is  Dr.  Lorant  Forizs, 
former  faculty  member  of  the  Department  of  Psy- 
chiatry of  the  U.N.C.  School  of  Medicine.  The 
awards  were  made  here  and  Dr.  Forizs  was  on 
hand   for  the   presentations. 

The  theses  submitted  by  the  four  physicians 
were  required  as  a  part  of  their  specialized  train- 
ing in  psychiatry.  All  four  men  completed  their 
training   in   June. 


News  Notes  from  the 
Bowman  Gray  School  of  Medicine 

Dr.  C.  C.  Carpenter,  dean  of  the  Bowman  Gray 
School  of  Medicine,  has  announced  that  on  July  1 
Dr.  William  H.  Boyce  will  assume  his  new  duties 
as  director  of  the  Section  on  Urology,  Department 
of  Surgery.  He  will   replace  Dr.   Fred   K.   Garvey. 

Dr.  Garvey,  head  of  the  section  since  1941,  will 
continue  as  professor  of  urology  on  the  full-time 
faculty  of  the  medical  school  and  on  the  staff  of 
the  urologic  service  of  the  North  Carolina  Baptist 
Hospital. 

Dr.  Boyce,  a  graduate  of  Vanderbilt  University 
School  of  Medicine,  completed  his  residency  train- 
ing in  urology  at  the  Cornell  University  Medical 
Center  and  the  University  of  Virginia  Hospital  be- 
fore joining  the  faculty  of  the  Bowman  Gray 
School  of  Medicine  in  1952.  He  has  made  outstand- 
ing- contributions  in  the  field  of  research  and  has 
contributed  widely  to  the  medical  literature.  He  is 
a  member  of  the  American  Association  of  Genito- 
urinary Surgeons,  the  American  Board  of  Urology, 
the  Clinical  Society  of  Genito-Urinary  Surgeons 
and  the  Society  of  University  Surgeons. 


304 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July,   19(50 


Three  new  faculty  appointments  have  been  an- 
nounced by  the  dean  of  the  Bowman  Gray  School 
of  Medicine. 

The  appointments,  effective  July  1,  are:  Dr. 
Henry  S.  Miller,  instructor  in  internal  medicine; 
Dr.  Herman  E.  Schmid,  Jr.,  instructor  in  physiol- 
ogy and  pharmacology;  and  Dr.  Robert  P.  Thomas, 
instructor  in  ophthalmology. 

Dr.  Miller  is  a  graduate  of  Bowman  Gray 
School  of  Medicine  and  has  just  finished  his  resi- 
dency training  in  medicine  here. 

Dr.  Schmid,  a  graduate  of  the  University  of 
Chicago  College  of  Medicine,  interned  at  the  Mil- 
waukee County  Hospital,  Milwaukee,  Wisconsin, 
and  served  as  a  house  physician  at  the  Santa  Cruz 
County  Hospital,  Santa  Cruz,  California.  He  has 
also  served  one  year  as  administrator  of  the 
Grants  and  Training  Branch,  National  Heart  In- 
stitute, National  Institutes  of  Health,  Bethesda, 
Maryland. 

Dr.  Thomas  is  a  graduate  of  the  University  of 
North  Carolina  School  of  Medicine  and  was  en- 
gaged in  general  practice  for  two  years  before 
joining  the  house  staff  of  the  North  Carolina  Bap- 
tist Hospital  in  1957  as  an  assistant  resident  in 
ophthalmology. 


*      *      * 


Dr.  C.  Hampton  Mauzy,  professor  of  obstetrics 
and  gynecology,  has  assumed  supervision  of  ob- 
stetrics at  the  medical  school  and  the  N.  C.  Bap- 
tist Hospital  under  the  chairmanship  of  Dr.  Frank 
R.  Lock.  This  will  enable  Dr.  Lock  to  devote  more 
of  his  time  to  the  direct  supervision  of  gynecologic 
work.  Dr.  Mauzy  joined  the  faculty  of  the  medical 
school  in  1941. 


Dr.  Frank  H.  Hulcher,  instructor  in  biochemis- 
try, is  engaged  in  work  as  i-esearch  collaborator  at 
the  Brookhaven  National  Laboratories,  Upton. 
Long  Island,  New  York,  for  the  months  of  June, 
July  and  August. 


Dr.  Wingate  M.  Johnson,  professor  emeritus  of 
clinical  internal  medicine,  presented  a  paper  en- 
titled, "Medical  Care  of  Older  Patients,"  at  the 
June  meeting  of  the  American  Medical  Associa- 
tion at  Miami  Beach,  Florida.  Dr.  Johnson  is  a 
former  trustee  of  the  A.M. A.  and  an  ex-officio 
member  of  the  House  of  Delegates.  He  is  also  on 
the  national  and  state  committees  for  care  of  the 
aged. 

*  *  * 
Dr.  Howard  H.  Bradshaw,  chairman  of  the  De- 
partment of  Surgery,  delivered  the  first  Julian  A. 
Moore  Memorial  Lecture  at  the  June  meeting  of 
the  Buncombe  County  Medical  Society  in  Asheville. 
The  title  of  Dr.  Bradshaw's  talk  was,  "Advances 
Made  in  Surgical  Treatment  of  Pulmonary  Tuber- 
culosis." 


On  July  1,  101  doctors  will  begin  house  staff  ap- 
pointments at  the  North  Carolina  Baptist  Hospital 
and  the  Bowman  Gray  School  of  Medicine.  Of  the 
total  number,  68  doctors  have  served  previous 
residencies  and  internships  here,  and  33  are  be- 
ginning training  here  for  the  first  time. 

The  new  appointments   are: 

Anesthesiology:  assistant  resident — Dr.  J.  Rich- 
ard  R.   Bobb. 

Medicine:  resident — Dr.  Thomas  N.  Massey,  Jr.; 
assistant  residents — Drs.  Dean  F.  Gray,  John  D. 
Hines,  Phillip  A.  Sellers;  interns — Drs.  John  D. 
Bradley,  Jr.,  Paul  R.  Brown,  Milton  S.  Goldman, 
James  N.  Hinson,  George  William  Joyce,  John 
Scott  Miller,  Jr.,  Bernard  S.  Morse,  and  Isaiah  J. 
Seligman. 

Neurosurgery:  assistant  resident — Dr.  Trave  L. 
Brown,  Jr. 

Obstetrics  and  Gynecology:  assistant  residents 
— Drs.  Sam  Jones  Crawley,  Jr.  and  Edward  C. 
Sutton. 

Ophthalmology:  assistant  resident — Dr.  Withrow 
R.  Legge,  Jr. 

Orthopaedics:  assistant  residents — Drs.  Louis  B. 
Daniel,  Jr.  and   Frank   Sellers. 

Otolaryngology:  assistant  resident — Dr.  Robert 
F.  Thompson. 

Pathology:  assistant  residents — Drs.  William  R. 
Beach,  III,  Stephen  Mamick,  Modesto  Scharyj, 
and  Franklin  Bailey  Wilkins;  intern — Dr.  Robert 
E.   Jones,   Jr. 

Pediatrics:   assistant   resident — Dr.    Max   Lassiter. 

Radiology:  assistant  residents — Drs.  James  V. 
Blazek,  Ronald  L.  Kelly,  Jr.,  and  James  L.  Quinn, 
III. 

Surgery:  assistant  residents — Drs.  W.  Claude 
Hollingsworth,  William  G.  Montgomery,  and  Earl 
P.   Welch;   intern — Dr.   Tim   Pennell. 

Four  new  physicians  have  been  appointed  for 
postdoctoral  training  as  fellows.  They  are:  Drs. 
William  B.  Courtney,  Fritz  R.  Dixon,  and  Sidney 
Girsch,  pathology;  and  Richard  B.  Patterson, 
pediatric-hematology. 


News  Notes 

Dr.  C.  A.  Kimel  has  announced  the  opening  of 
his  office  for  general  practice  at  Ebert  Street  Ex- 
tension and  West  Clemmonsville  Road,  Winston- 
Salem. 


EDGECOMBE-NASH    MEDICAL    SOCIETY 

The  monthly  meeting  of  the  Edgecombe-Nash 
Medical  Society  was  held  in  Rocky  Mount  on 
June  8. 

Dr.  A.  W.  Hedgepeth,  program  chairman  for 
June,  introduced  the  speaker,  Dr.  Paul  Bunch,  who 
discussed  pediatric  surgery  from  a  urologic  stand- 
point. 


July,   1960 


BULLETIN   BOARD 


305 


Inter-State  Post-Graduate  Association 

The  Inter-State  Post-Graduate  Association  will 
hold  its  forty-fifth  Scientific  Assembly  at  the 
Pittsburgh  Hilton  Hotel  on  October  31  to  Novem- 
ber 3.  Pre-registration,  accommodations,  informa- 
tion, and  other  communications  may  be  addressed 
to  Mr.  Roy  T.  Ragatz,  Executive  Director,  at  Box 
1109,  Madison  1,  Wisconsin. 

Twenty-one  of  the  subjects  are  to  be  devoted  to 
subject  of  medicine,  nine  to  surgery,  one  to  radiol- 
ogy, one  to  otolaryngology,  and  one  to  social  ec- 
onomics. 

The  program  is  approved  for  postgraduate  edu- 
cation, Category  I,  by  the  American  Academy  of 
General    Practice. 


having  programs  in  Chile.  These  included  Catholic 
Relief  Service,  Church  World  Service,  CARE, 
Seventh  Day  Adventists  Welfare  Service,  and  the 
Church   of  Jesus  Christ  of   Latter  Day   Saints. 

As  General  Gruenther  explained,  "The  impact  of 
voluntary  contributions  by  individuals  on  the  suf- 
fering people   of   Chile  will   be   tremendous." 

In  addition  to  the  contributions  of  individuals, 
tons  of  food,  medical  supplies,  tents  and  other  aid 
were  immediately  airlifted  to  help  the  homeless 
and  the  helpless.  The  American  Red  Cross  and 
numerous  other  organizations  made  emergency 
allocations  from  their  own  funds  and  began  to 
campaign  for  funds  and  relief  supplies  for  a  long- 
range  program  to  help  the  people  of  Chile. 


American  Board  of 
Obstetrics  and  Gynecology 

The  next  scheduled  examination,  (Part  I),  writ- 
ten, will  be  held  in  various  cities  of  the  United 
States,  Canada,  and  military  centers  outside  the 
Continental  United  States,  on  Friday,  January  13, 
1961. 

Candidates  submitting  applications  in  1960  for 
the  1961  examinations  are  not  required  to  submit 
case  reports  as  previously  required  to  complete 
the  Part  I  examinations  of  this  Board.  In  lieu  of 
this  requirement,  new  candidates  are  required  to 
keep  in  their  files  a  duplicate  list  of  hospital  ad- 
missions as  submitted  with  their  application,  for 
submittal  at  the  annual  meeting  in  Chicago  should 
they  become  eligible  to  take  the  Part  II  (oral)  ex- 
aminations. 

Reopened  candidates  will  be  required  to  submit 
case  reports  for  review  thirty  days  after  notifica- 
tion of  eligibility.  Scheduled  Part  I  and  candidates 
resubmitting  case  reports  are  required  to  submit 
Case   Reports   prior  to   August   1   each  year. 

Current  bulletins  may  be  obtained  by  writing  to: 
Robert    L.    Faulkner,    M.D. 
Executive    Secretary   and    Treasurer 
2105  Adelbert  Road 
Cleveland   6,   Ohio 


AMERICAN   NATIONAL   RED    CROSS 
The     Chilean     earthquake     disaster,     one     of    the 
worst    in    modern    times,    has    demonstrated     again 
the   characteristic   generosity   of   Americans    toward 
people  in  trouble. 

Chile  suffered  this  disaster  during  May,  leaving 
hundreds  of  thousands  of  Chileans  cold,  sick,  in- 
jured and  homeless.  Not  only  was  emergency  re- 
lief needed  but  a  long-range  recovery  program  of 
gigantic   pi-oportions    was    necessary. 

At  President  Eisenhower's  request,  General  Al- 
fred M.  Gruenther,  president  of  the  American  Red 
Cross,  became  coordinator  for  voluntary  Chilean  re- 
lief. Citizens  were  urged  to  make  their  contribu- 
tions to  the  American  Red  Cross  or  other  agencies 


AMERICAN  COLLEGE  OF  SURGEONS 
Improvement  in  the  total  care  of  surgical  pa- 
tients will  be  the  goal  of  10,000  doctors  expected 
to  attend  the  forty-sixth  annual  Clinical  Congress 
of  the  American  College  of  Surgeons  in  San  Fran- 
cisco,   California,   October   10   through   14. 

More  than  1,000  participants  will  take  part  in 
the  various  programs  as  authors  of  research  re- 
ports, teachers  of  postgraduate  courses,  partici- 
pants in  panel  discussions,  lecturers,  and  operating 
surgeons  in  motion  pictures  and  closed-circuit  tele- 
casts. 

On  the  final  evening,  October  14,  initiates  will  be 
presented  for  fellowship,  honorary  fellowships  con- 
ferred, and  officers  inaugurated. 


NATIONAL   LEAGUE    FOR   NURSING   INC. 

Admissions  to  schools  of  professional  and  prac- 
tical nursing  reached  an  estimated  71,297  new 
students  in  1959,  compared  with  68,851  in  1958, 
according  to  an  announcement  by  Fred  C.  Foy, 
chairman,  Committee  on  Careers,  National  League 
for  Nursing,   New  York. 

Professional  nursing  programs  admitted  47,797 
new  students,  a  slight  increase  over  the  47,351  ad- 
missions of  the  preceding  year.  Practical  nursing 
schools  enrolled  an  estimated  23,500  students  in 
1959,  compared  with  21,500  in  1958. 


CATHOLIC  HOSPITAL  ASSOCIATION 
Officers  elected  at  the  forty-fifth  annual  con- 
vention of  the  Catholic  Hospital  Association  of  the 
United  States  and  Canada  in  Milwaukee,  Wiscon- 
sin, recently  included  The  Rt.  Rev.  Msgr.  A.  W. 
Jess,  Camden,  New  Jersey,  who  took  over  the  du- 
ties of  president  from  Father  John  J.  Humensky, 
Cleveland,  Ohio.  Sister  M.  Christine,  C.  C.  V.  I., 
of  St.  Joseph's  Hospital,  Houston,  Texas,  was 
elected  to  represent  the  Southern  section  of  the 
United  States,  and  Sister  John  Joseph,  C.S.J.,  of 
Santa  Rosa  Hospital,  Santa  Rosa,  California,  to 
represent  the  Western  section. 


nut; 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July.   19G0 


AMERICAN  HEARING  SOCIETY 
Philip  M.  Morgan,  industrialist,  civic  leader,  and 
philanthropist  of  Worcester,  Massachusetts,  was 
re-elected  president  of  the  American  Hearing  So- 
ciety at  its  forty-first  annual  conference  in  Detroit 
(May  24-27),  attended  by  professional  workers  in 
the  field  of  hearing  and  representatives  of  the 
agency's  lay  membership  from  all  pails  of  the 
country.  Program  for  the  four-day  meeting  cen- 
tered on  the  theme  "Communication:  Key  to  Liv- 
ing." 

Re-elected  as  officers  of  the  society  were:  first 
vice  president — Miss  Mary  E.  Switzer,  director, 
Office  of  Vocational  Rehabilitation,  Department  of 
Health,  Education,  and  Welfare;  second  vice  pres- 
ident— James  McKnight  Timmons,  M.D.;  of  Co- 
lumbia, South  Carolina,  and  treasurer — E.  B. 
Whitten,  executive  director  of  the  National  Re- 
habilitation  Association. 


Biological  Photographic  Association  Inc. 

Photographers  and  scientists  interested  in  the  ap- 
plication of  new  photographic  techniques  and 
equipment  in  the  field  of  biology  will  convene  in 
Salt  Lake  City,  Utah,  this  summer  for  the 
thirtieth  annual  meeting  of  Biological  Photographic 
Association.  The  meeting  will  be  held  August  23 
through  26,  with  headquarters  at  the  Hotel  Utah 
Motor  Lodge. 


AMERICAN  GERIATRICS  SOCIETY 
The  Willard  0.  Thompson  Memorial  Award  "for 
distinguished  contributions  to  geriatric  medicine" 
was  presented  to  Dr.  William  B.  Kountz  of  St. 
Louis,  Missouri,  at  the  annual  dinner  of  the  Amer- 
ican Geriatrics  Society  held  recently  at  Miami 
Beach. 

Presentation  of  the  award  was  made  by  Dr.  Ed- 
ward Henderson,  chairman  of  the  Society's  Award 
Committee  and  editor  of  the  Journal  of  the  Amer- 
ican Geriatrics  Society,  on  the  occasion  of  the  so- 
ciety's seventeenth  annual  meeting.  A  professional 
organization  with  a  membership  of  more  than 
7,000  physicians,  the  society  has  as  its  purpose 
encouraging  and  promoting  the  study  of  geriatrics. 
The  Willard  O.  Thompson  Memorial  Award,  which 
includes  an  honorarium  and  a  medal,  is  given  an- 
nually to  an  outstanding  specialist  in  geriatric 
medicine. 


BLUE  SHIELD  MEDICAL  CARE  PLANS 
Chairman  of  the  Board  of  the  National  Asso- 
ciation of  Blue  Shield  Plans,  was  named  one  of 
three  national  civic  leaders  to  receive  the  I960 
"Health-USA"  award  sponsored  jointly  by  the 
Metropolitan  Washington  (D.C.)  Board  of  Trade 
and  the  Medical  Society  of  the  District  of  Colum- 
bia. Dr.  Stubbs,  who  has  held  important  posts  in 
Blue    Shield    both    at  the    local    and   national    levels 


adult 

stable 
diabetics 

and  a 

significant 

number  of 

sulfonylurea 

failures 
respond  to 


trademark, 
brand  of  Phenformin  HCI 


adult  stable  diabetes 

"In  our  experience  the  action  of  DBI  on  the  adult  stable 
type  of  diabetes  is  impressive  .  .  .  88%  were  well  controlled 
by  DBI."i 

"Most  mild  diabetic  patients  were  well  controlled  on  a 
biguanide  compound  [DBI],  and  such  control  was  occa- 
sionally superior  to  that  of  insulin.  This  was  true  regardless 
of  age,  duration  of  diabetes,  or  response  to  tolbutamide."2 

"DBI  has  been  able  to  replace  insulin  or  other  hypogly- 
cemic agents  with  desirable  regulation  of  the  diabetes  when 
it  is  used  in  conjunction  with  diet  in  the  management  of 
adult  and  otherwise  stable  diabetes."3 


sulfonylurea  failures 

Among  those  diabetics  who  responded  to  tolbutamide  ini- 
tially and  became  secondary  failures  DBI  "gave  a  satis- 
factory response  in  55%. "4 

"DBI  is  capable  of  restoring  control  in  a  considerable  por- 
tion of  patients  in  whom  sulfonylurea  compounds  have 
failed,  either  primarily  or  secondarily."5 

"All  twelve  secondary  tolbutamide  failures  have  done  well 
on  DBI."6 

"34  out  of  59  sulfonylurea  primary  failures  were  success- 
fully treated  with  DBI."7 


July,   1960 


BULLETIN   BOARD 


307 


during  the  past  decade,  was  selected  for  ".  . . .  his 
distinguished  contributions  to  the  health  of  the 
American  people."  Dr.  Stubbs  received  the  "Health- 
USA"  award  at  a  testimonial  luncheon  held  in 
Washington,  D.  C.  on  June  1.  Present  at  the  award 
luncheon  were  Secretary  Flemming,  members  of 
Congress  and  medical  leaders. 

The  two  other  recipients  of  the  "Health-USA" 
awards,  which  are  given  annually  to  recognize 
"Statesmanship  in  Health,"  are  Major  General 
Howard  McC.  Snyder,  physician  to  the  President  of 
the  United  States,  and  Elmer  H.  Bobst,  Chairman 
of  the  Board  of  Warner-Lambert  Pharmaceutical 
Company. 


U.  S.  Department  of 
Health,  Education,  and  Welfare 

Douglas  H.  K.  Lee,  M.D.,  has  been  appointed 
chief  of  the  research  headquarters  of  the  Occu- 
pational Health  Program,  Public  Health  Service, 
U.  S.  Department  of  Health,  Education,  and  Wel- 
fare, at  Cincinnati,  Ohio.  In  his  new  position,  Dr. 
Lee  will  be  responsible  for  directing  technical  re- 
search and  field  studies  of  occupational  health 
problems  and  professional  and  technical  consulta- 
tion services  to  state  agencies,  labor,  and  industry. 


Statement  by   Surgeon   General   Leroy  E.   Burney 

Public  Health  Service  scientists  have  been  at- 
tending the  Second  International  Conference  on 
Poliomyelitis  which  has  been  meeting  in  Washing- 
ton this  week  under  the  auspices  of  the  World 
Health  Organization.  During  the  past  year  our 
staff  have  been  following  very  closely  the  live 
virus  trials  in  various  parts  of  the  world.  This 
week,  as  a  matter  of  fact,  Dr.  David  E.  Price,  who 
served  as  my  personal  representative  at  a  series 
of  polio  meetings  in  Moscow  in  mid-May,  has 
made  public  a  report  on  the  use  of  live  virus  in 
the  USSR  during  the  past  year. 

I  want  to  emphasize  very  strongly  that  the  Pub- 
lic Health  Service  and  I,  as  Surgeon  General,  have 
the  responsibility  for  making  sure  that  biological 
products  are  safe  and  effective.  We  take  that  re- 
sponsibility very  seriously.  When  the  technical  ex- 
perts of  the  National  Institutes  of  Health  and 
their  highly  competent  advisers  are  satisfied  on 
these  two  points,  it  will  be  possible  to  license  a 
live  polio  vaccine  but  not  before.  How  soon  that 
will  be,  I  do  not  know. 

I  should  point  out  that,  so  far,  only  one  manu- 
facturer has  applied  for  a  license.  This  request 
was  returned  for  additional  information;  and  no 
applications  are  now  pending. 

In  the  meantime  we  have  in  the  Salk  vaccine  a 
proved    and    highly    effective    means    for    fighting 


lowers 
blood  sugar 

in  mild, 

moderate 

and  severe 

diabetes, 

in 

children 


not  a  sulfonylurea... DBI 

(N1-(3-phenethylbiguanide)  is 
available  as  white,  scored  tablets  of 
25  mg.  each,  bottles  of  100. 

Send  for  brochure  with  complete  dosage 
instructions  for  each  class  of  diabetes, 
and  other  pertinent  information. 


1.  Walker,  R.  S.:  Brit.  M.  J.  2:405.  1959. 

2.  Odell,  W.  D.,  et  al.:  A.M. A.  Arch.  Int.  Med. 
102:520,  1958. 

3.  Pearlman,  W.:  Phenformin  Symposium. 
Houston,  Feb.  1959. 

4.  DeLawter,  D.  E.,  et  al.:  J.A.M.A.  171:1786 
(Nov.  28)  1959. 

5.  McKendry,  J.  B.,  et  al.:  Canad.  M.  A.  J. 
80:773,  1959. 

6.  Miller,  E.  C:  Phenformin  Symposium, 
Houston,  Feb.  1959. 

7.  Krall,  L.  P.:  Applied  Therapeutics  2:137,  1960. 

an  original  development  from  the  research 
laboratories-  of 

u.  s.  vitamin  &  pharmaceutical  corp. 

Arlington-Funk  Laboratories,  division 
250  East  43rd  Street,  New  York  17,  N.  Y. 


308 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July,   19K0 


polio.  It  has  been  administered  to  about  80  million 
Americans  during  the  past  five  years,  and,  despite 
a  high  polio  incidence  in  the  summer  of  1950,  it 
has  proved  over  90  percent  effective  when  the  re- 
commended  course   of   injections   is   followed. 

Unquestionably,  a  vaccine  which  can  be  admin- 
istered orally  and  is  less  expensive  to  produce 
would  represent  another  major  advance  in  the 
fight  against  polio  throughout  the   world. 

We  want  to  be  very  sure  that  it  is  entirely  safe 
and  fully  effective.  When  these  two  principles  are 
fully  established  by  a  qualified  manufacturer,  we 
will   be   happy   to  grant   licenses  for   its    production. 


United  States  Civil  Service  Commission 

The  Civil  Service  Commission  has  announced 
the  appointment  of  a  five-man  committee,  repre- 
senting the  health  insurance  industry,  to  advise  it 
in  connection  with  the  government-wide  indemnity 
benefit  plan,  one  of  four  types  of  health  benefit 
plans  to  be  offered  federal  employees  under  the 
new    Federal    Employees   Health    Benefits    program. 

Classified  Advertisements 

X-RAY  Equipment  for  sale  or  exchange.  100  K.V. 
100  M.A.  Picker  Radiographic  unit  with  manual 
operated  tilt  table  combined  with  Fluoroscope 
unit  beneath  the  table.  Provides  instant  change 
over  from  Fluoroscopy  to  Radiography  with  spot 
film  device.  Has  had  some  use  but  is  in  excellent 
working  order  also  dark  room  equipment,  mag- 
netic type  plate  changer.  Stereoscopic  view  boxes, 
etc.,  will  consider  late  model  Ultra-violet  lamp, 
surgical  endotherm  in  exchange.  Write  Box  790. 
Raleigh,    North    Carolina. 

AVAILABLE  Desirable  twelve  hundred  and  fifty 
square  feet  space  suitable  for  doctors  or  dentist, 
(iround  floor  Cameron  Court  apartments,  corner 
Snow  and  Morgan  Streets,  Raleigh.  Air  con- 
ditioned, also  heat,  lights,  water  and  parking. 
On  long  lease  will  improve  to  suit  tenant.  Apply 
A.   W.   Criddle,   Manager,  Temple   2-5395. 

OPENINGS  for  psychiatrists,  pediatricians  and 
general  physicians  for  varied  assignments  with 
North  Carolina  state  hospitals  and  institutions 
for  retarded  children.  Several  locations  available. 
Opportunity  for  all  types  of  therapy,  collabora- 
tion or  individual  research  in  service  training. 
Medical  school  affiliations  offers  opportunity  for 
university  appointment.  Entire  program  operates 
in  close  association  with  university  program.  Re- 
tirement, Social  Security,  and  other  attractive 
benefits  including  recent  substantial  increase  in 
salaries  for  psychiatrists,  pediatricians  and  gen- 
eral physicians.  For  particulars  write  Eugene 
A.  Hargrove,  M.D.,  Commissioner  of  Mental 
Health,    P.O.    Box    70,    Raleigh,    North    Carolina. 

DESIRABLE  LOCATION  for  a  physician.  Contact 
Godley  Realty  Company,  Mt.  Holly  Road,  Char- 
lotte,  North    Carolina. 


The  Month  in  Washington 

An  omnibus  bill  approved  by  the  House 
Ways  and  Means  Committee  contains  two 
provisions  of  major  importance  to  physi- 
cians— Social  Security  coverage  for  doctors 
and  a  federal-state  program  to  provide 
health  care  for  older  persons  with  low  in- 
comes. 

About  150,000  self-employed  physicians 
would  be  covered  by  Social  Security  on  the 
same  basis  as  lawyers,  dentists  and  other 
self-employed  professional  people  now  are 
covered.  Becoming  effective  for  taxable 
years  ending  on  December  31,  I960,  or 
June  30,  1961,  self-employed  physicians 
would  be  required  to  pay  a  Social  Security 
tax  of  4'o  per  cent  of  the  first  $4,800  of 
income.  Physicians  also  would  be  subject 
to  the  automatic  increases  in  the  Social  Se- 
curity tax  in  future  years. 

Medical  and  dental  interns  would  be 
covered  for  the  first  time  also. 

Representative  Wilbur  Mills  (D.,  Ark.), 
Chairman  of  the  Ways  and  Means  Commit- 
tee, was  the  main  architect  of  the  health 
program  for  "medically  indigent"  aged.  It 
was  designed  to  provide  a  broad  range  of 
hospital,  medical  and  nursing  services  for 
persons  65  years  of  age  and  older  who  are  I 
able  financially  to  take  care  of  their  ordin- 
ary needs  but  not  large  medical  expenses.    I 

It  would  be  up  to  each  state  to  decide 
whether  it  participates  in  the  program.  The 
extent  of  participation  —  the  number  of 
benefits  offered  to  older  persons — also 
would  be  at  the  option  of  individual  states. 

The  states  would  determine  the  eligibility 
of  older  persons  to  receive  benefits  under 
the  program.  However,  the  legislation  laid 
down  a  general  framework  for  eligibility; 
persons  65  years  and  older,  whose  income 
and  resources  —  taking  into  account  their 
other  living  requirements — are  insufficient 
to  meet  the  cost  of  their  medical  care. 

The  program  couldn't  become  effective : 
until  July  1,  1961.  Before  putting  such  a 
program  into  effect,  a  state  would  have  ta 
submit  to  the  federal  government  a  plan 
meeting  the  general  requirements  outlined 
in  the  legislation. 

The  program  would  be  financed  jointly 
by  the  federal  and  state  governments.  Fed- 
eral grants  would  have  to  be  matched  by 
participating  states   on   the   same   basis   as 


From      Wrashingrton      Office.      American      Medical      Association 
1523    L    Street.    N.W. 


July,   1960 


THE    MONTH   IN   WASHINGTON 


309 


under  the  present-old  age  assistance  formu- 
la. 

States  could  elect  to  provide,  with  federal 
financial  aid,  any  or  all  of  the  following 
benefits:  (1)  Inpatient  hospital  services  up 
to  120  days  per  year;  (2)  skilled  nursing- 
home  services;  (3)  physicians'  services; 
(4)  outpatient  hospital  services;  (5)  or- 
ganized home  care  services;  (6)  private 
duty  nursing  services;  (7)  therapeutic 
services;  (8)  major  dental  treatment;  (9) 
laboratory  and  x-ray  services  up  to  $200 
per  year,  and  (10)  prescribed  drugs  up  to 
$200  per  year. 

The  committee  put  a  $325  million  price 
tag  on  the  program  for  the  first  full  year 
of  operation  —  $185  million  federal  and 
$140  million  state.  This  estimate,  however, 
could  hardly  be  more  than  an  educated 
guess  of  sorts.  The  actual  cost  would  de- 
pend upon  unpredictable  factors  —  how 
many  states  would  participate,  how  many 
benefits  they  would  offer,  and  how  many 
older  persons  would  qualify  and  what  serv- 
ices they  would  require. 

The  committee  estimate  was  based  on 
between  500,000  and  1  million  older  per- 
sons a  year  receiving  health  services  under 
the  program.  If  all  states  participated 
fully,  the  committee  said,  potential  protec- 
tion would  be  provided  as  many  as  10  mil- 
lion aged  whose  financial  resources  are  so 
limited  that  they  would  qualify  in  case  of 
serious  or  extensive  illness. 

Payments  under  the  program  would  go 
directly  to  physicians  and  other  providers 
of  medical,  hospital  and  nursing  services. 

In  addition  to  the  federal  grants  for  the 
"medically  indigent,"  about  $10  million 
more  in  federal  funds  would  be  authorized 
for  payment  to  states  for  raising  the  stan- 
dards of  medical  care  benefits  under  pre- 
sent public  assistance  programs  for  older 
persons. 

The  approach  of  the  Mills  program  was 
similar  to  that  of  Point  2  of  the  American 
Medical  Association's  8-point  program  for 
health  care  of  the  aged.  Point  2  stated  that 
the  A.M. A.  supports  federal  grants-in-aid 
to  states  "for  the  liberalization  of  existing 
old-age  assistance  programs  so  that  the 
near-needy  could  be  given  health  care  with- 
out having  to  meet  the  present  rigid  re- 
quirements for  indigency."  Such  a  liberal- 
ized definition  of  eligibility  should  be  de- 
termined locally,  the  A.M. A.  said. 


Approval  of  the  Mills  plan  by  the  com- 
mittee marked  a  sharp  setback  for  organ- 
ized labor  leaders.  But  they  continued  their 
all-out  pressure  campaign  in  an  effort  to 
get  Congressional  approval  of  Forand-type 
legislation  that  would  use  the  Social  Secur- 
ity system  to  provide  hospitalization  and 
medical  care  for  the  aged.  After  being  de- 
feated in  the  Ways  and  Means  Committee, 
labor  union  leaders  and  other  supporters  of 
Forand-type  legislation  directed  their  ma- 
jor efforts  to  trying  to  get  the  Senate  to 
substitute   the   Social    Security   approach. 

The  committee  had  been  considering 
health-care-for-the-aged  legislation  intermit- 
tently for  more  than  a  year.  Hearings  were 
held  on  the  Forand  bill  last  summer  but 
action  was  postponed  until  this  year. 
(CONTINUED  ON   PAGE  312) 


BOOK  REVIEWS 

Biology     of     the    Pleuropneumonialike     Or- 
ganisms.   Annals   of  the   New   York    Acad- 
emy of  Sciences,  Vol.  79,  Article  10,  pages 
305-758,  1960. 
This   publication   of   the    New   York   Academy    of 
Sciences   emphasizes  the  increasing-  interest   in  the 
pleuropneumonia    group   of   organisms    which    here- 
tofore  have   been   of   primary   concern   to   taxonom- 
ists   and   veterinary   bacteriologists. 

Contributions  by  80  authors  cover  the  present 
state  of  knowledge  concerning  the  morphology, 
classification,  isolation,  cultivation,  physiology, 
serology,  chemotherapy,  and  pathogenicity  of  the 
pleuropneumonia  group  of  organisms.  It  is  fair  to 
say  that  more  questions  are  raised  than  are  an- 
swered, but  this  only  serves  to  indicate  the  need 
for   further  investigations. 

The  important  question  of  the  pathogenicity  of 
the  pleuropneumonia  organisms  for  humans  is  not 
completely  answered.  The  isolation  of  PPLO  from 
approximately  70  per  cent  of  more  than  500  cases 
of  primary  and  recurrent  nongonococcal  urethritis 
by  Shepard  would  indicate  more  than  a  casual  re- 
lationship. Similar  results  have  been  obtained  by 
others  when  studying  women  with  pelvic  inflam- 
matory disease  and  patients  with  acute  hemor- 
rhagic cystitis.  The  pathogenic  capabilities  are 
not  clear-cut,  however,  since  PPLO  can  be  isolated 
from  the  genitourinary  tracts  of  supposedly 
normal  males  and  females.  As  Dr.  H.  E.  Morton 
states  on  page  613:  "Trying  to  relate  PPLO  to 
disease  is  very  difficult.  However,  when  PPLO  are 
isolated  in  pure  culture  from  the  genito-urinary 
tract  in  which  there  is  pathology,  and  antibiotics 
are  given,  and  when,  in  1  to  3  days  the  PPLO  dis- 
appear and  the  clinical  symptoms  begin  to  sub- 
side, this  is  good  circumstantial  evidence  that 
PPLO    were    causing    the     pathology."     Studies    on 


::io 


NORTH  CAROLINA  MEDICAL  JOURNAL 


July,   19(30 


PPLO-caused  avian  diseases  have  indicated  that 
a  superimposed  physiological  stress  may  be  a  re- 
quirement for  the  production  of  the  disease  state. 
In  addition  to  these  important  problems,  the  re- 
lationship of  PPLO  and  L  forms  of  bacteria  is 
discussed.  Of  interest  to  those  who  are  utilizing 
tissue  culture  techniques  in  their  research  are  the 
discussions  of  the  frequent  contamination  of  cell 
lines  with  PPLO. 


This  monograph  will  be  especially  useful  to  the 
worker  engaged  in  research  in  infectious  diseases 
and  to  the  practitioner  who  is  inquisitive  about 
current  viral  research  and  concepts. 


Radiopaque    Diagnostic    Agents.    Annals    of 

New   York    Academy   of   Sciences,    Vol.    71, 
Article  3,   pages   705-1020,    1959. 

This  colloquium  presents  an  extensive  survey  of 
the  past,  present  and  possible  future  of  radio- 
graphic media.  The  first  series  of  articles  discuss 
the  historical  development  and  the  chemical  and 
pharmacologic  properties  of  the  common,  pi-esent- 
day  media.  Four  articles  describe  experimental 
work  in  animals  with  heavy  metal  chelates  and 
colloidal  dispersions  used  as  contrast  agents.  The 
initial  results  were  mixed  and  somewhat  disap- 
pointing. Excellent  reviews  of  lymphadenography, 
splenoportography  with  liver  visualization,  pan- 
creatography, and  radioisotopic  liver  and  kidney 
up-take   studies   are   included. 

Various  clinical  and  technical  aspects  of  modern 
angiography  are  presented.  Dr.  J.  Stauffer  Leh- 
man's evaluation  of  high  concentrations  of  dia- 
trizoate  methyg^ucamine  in  angiography  is  par- 
ticularly worthy  of  note.  The  effect  of  tempera- 
ture, pre  sure,  and  catheter  size  on  speed  of  de- 
livery of  the  commonly  available  medin  is  de- 
scribed  in  two  succinct  graphs. 

The  last  group  of  four  articles  deals  with  the 
water  soluble  gastrointestinal  contrast  agents  and 
the  newer  contrast  agent;  for  examination  of  the 
genitourinary  tract  in  a  general  fashion,  citing 
extensive  clinical   experience. 


Virus     Virulence     and     Pathogenicity.     Ciba 
Foundation   Study   Group   No.  4.   Edited   by 
G.     E.     N.     Wolstenholme     and     Cecilia    M. 
O'Connor.      Boston:      Pubished     by     Little, 
Brown,   and  Company,    1960. 
During  the  past  decade  tremendous   strides   have 
been    made    in    our    understanding    of    viruses    and 
their  effects  on  the  human  host.  From  time  to  time 
interested    investigators     must     meet     and     discuss 
problems  of  a  general  nature  about  which  we  know 
less   than   is   desirable.    In    the    present   monograph, 
some   of   the   leading   virologists   in    the   world   met 
to   discuss  the  concept   of   virulence    and    pathogen- 
icity of  viruses. 

In  the  introduction,  pathogenicity  is  defined  "as 
the  power  to  produce  pathological  affects  in  a  host, 
and  virulence  as  the  evidence  of  pathogenicity  de- 
rived from  observation  of  the  symptoms  and 
signs,  degree  of  illness  or  death  of  the  host." 

During  the  course  of  the  conference  various 
host-cell  factors  and  human  volunteer  studies  were 
discussed. 


A  History  of  Neurology.  By  Walther 
Rieser,  M.D.  223  pages.  Price,  $4.00.  New- 
York:    MD    Publications,    1959. 

The  author  begins  his  discussion  of  neurology 
and  its  history  with  a  consideration  of  various 
functions  of  the  nervous  systems.  The  precedence 
of  structure  to  determine  function,  or  function  to 
determine  structure,  is  discussed  at  great  length 
in  a  somewhat  theologic  fashion.  In  like  manner, 
the  platonic  and  other  doctrines  regarding  the 
soul  are  related  to  progress  in  neurology.  Finally, 
various  philosophic  concepts  of  cerebral  localiza- 
tion  are   presented. 

Only  passing  mention  is  given  to  specific  men 
and  important  developments  in  neurology.  Brief 
reference  is  made  to  the  development  of  ideas  in 
the    treatment   of  neurologic    disorders. 

The  book  is  printed  neatly,  free  from  typographic 
errors,   well   indexed,   and   reasonably   priced. 

Although  of  interest  to  one  concerned  with  the 
evolution  of  philosophic  concepts  in  neurology, 
only  the  author's  approach  is  presented.  The  book 
would   not   serve   as  a  source   of  reference. 


Women  and  Fatigue  by  Marion  Hilliard, 
M.D.,  175  pp.,  price  $2.95,  New  York: 
Doubleday  and  Company,  Inc.,  1960. 
Women  and  Fatigue,  a  posthumous  sequel  to  the 
excellent  A  Woman  Doctor  Looks  at  Love  and  Mar- 
riage, is  both  a  source  book  for  physicians  whose 
women  patients  ask,  "Doctor,  why  am  I  so  tired?", 
and  a  manual  of  suggestions  for  such  patients. 
Chapter  titles,  such  as  "Fatigue  Has  Many 
Faces",  "Common  Sense  and  Calories",  and  "The 
Fallacy  of  the  Shortcut  to  Vitality",  indicate  the 
practical  nature  of  the  author's  approach;  while 
titles  such  as  "A  Time  To  Be  Born  and  a  Time  To 
Die"  and  "Love  God  and  Do  As  You  Please"  are  a 
guide  to  her  philosophy.  The  simplicity  of  this 
approach  is,  however,  an  insufficient  indication  of 
the  profundity  of  the  thought  and  the  breadth  of 
experience  in  helping  women  patients  conquer 
fatigue  problems  that  is  revealed  in  this  small 
volume. 

Zest  for  living,  throughout  the  entire  life's 
period  is  possible  for  women  of  all  ages,  married 
or  single,  is  the  thesis  which  runs  throughout  this 
book.  Such  zest  comes  from  entering  with  verve 
every  open  door  that  offers  a  genuine  opportunity 
As  there  is  a  time  to  be  born  and  a  time  to  die,  so, 
too,  there  is  a  time  to  be  young  and  helpless,  and 
a  time  for  growing  up;  a  time  for  falling  in  love; 
a  time  for  growing  older.  Through  meeting  all  ex- 
periences of  joy,  suffering,  sorrow,  contentment, 
achievement,  and  disappointment,  the  self  develops 
into  a  mature  person  in  step  with  chronological 
age. 


July,   1960 


BOOK  REVIEWS 


311 


It  was  this  reviewer's  privilege  to  have  our 
second  baby  delivered  by  Dr.  Hilliard.  She  was 
not  only  herself  a  vital  person,  but  one  became 
aware  that  through  contact  one's  own  revitaliza- 
tion  was  taking  place.  Dr.  Hilliard  never  married, 
so  she  knew  from  personal  experience  the  pro- 
blems of  the  single  woman  in  American  society. 
She  looked  at  these  unblinkingly,  and  supported 
herself  by  such  humor  as  "When  night  falls  after 
a  long  day  of  seeing  patients,  I  sometimes  have  a 
fanciful  vision:  all  the  married  women  are  bitter- 
ly thinking  up  ways  to  avoid  making  love,  and  all 
the  unmarried  women  are  just  dying  to  get  at  it" 
(page  108). 

Dr.  Hilliard  lived  for  a  "cause":  to  get  women 
to  work  out  an  intellectual  attack  on  their  fatigue 
problems,  and  by  overcoming  them  benefit  family, 
friends,  neighbors  and  community.  Physicians, 
married  or  unmarried,  male  or  female,  will  find 
themselves  using  this  book  to  review  and  evaluate 
their  own  ways  of  treating  patients  who  are  bored, 
lonely,  unable  to  love  or  to  make  love,  the  gen- 
uinely overworked,  the  secretly  fearful  or  guilty, 
and  the   uncertain. 


The  Story  of  Dissection.  By  Jack  Kevor- 
kian, M.D.,  New  York:  Philosphical  Li- 
brary.  1959. 

The  author  has  neglected  no  period  from  ear- 
liest history  to  the  beginning  of  the  twentieth 
century  in  his  anatomic  considerations.  In  a  very 
small  volume  a  wealth  of  information  has  been 
presented,  which  makes  not  only  engrossing  read- 
ing, but  serves  as  a  valuable  addition  to  reference 
material. 

A  sincere  attempt  has  been  made  to  explain  the 
progress,  or  lack  of  progress,  not  only  in  dissec- 
tion and  the  anatomical  knowledge  derived,  but  in 
medical  science  in  general,  in  the  light  of  existing 
conditions  and  opinions  of  each  successive  era.  It 
is  only  to  be  regretted  that  more  lengthy  discus- 
sions could  not  have  been  included  in  this  survey. 
Finally,  the  author  is  to  be  congratulated  on  the 
excellence  of  his  composition  and  style. 


The  Teen-Age  Years:  A  Medical  Guide  for 
Young  People  and  Their  Parents.  By 
Arthur  Roth,  M.D.  288  pages.  Price,  $3.75. 
New   York:    Doubleday   &    Company,   1960. 

This  book  is  the  result  of  six  years  of  exper- 
ience on  the  part  of  the  author  as  founder-director 
of  the  Teen-age  Clinic  at  the  Kaiser  Foundation 
Medical    Center    in    Oakland,    California.     It    deals 


specifically  with  medical  problems  of  the  adoles- 
cent. Among  the  topics  discussed  are  problems  of 
sexual  maturing,  skin  care  and  grooming,  ortho- 
pedic problems,  and  the  vague  ailments — "aches" 
and  "tiredness" — common  to  young  people.  Dr. 
Roth  also  explores  the  standards  of  normalcy  in 
adolescence  and  explodes  what  he  calls  "the  false 
cult  of  the  average":  the  teen-ager's  acute  worry 
that  he  is  too  tall,  too  short,  too  anything 
that  is  not   "normal." 

Dr.  Roth  received  his  M.D.  degree  from  Western 
Reserve  University  and  served  his  internship  and 
pediatric  residence  in  California  and  at  Boston 
Children's  Medical  Center.  The  staff  of  his  teen- 
age clinic  at  Oakland  now  numbers  nine,  and  the 
case  load  has  climbed  from  25  to  nearly  500 
monthly. 


Biological   Stains — A    Cross   Index 
A   new   technical  reference   booklet   dealing   with 
the   uses    of    Biological    Stains    has    been    published 
by  Allied   Chemical's   National   Aniline  Division. 

The  12-page  booklet  cross-indexes  an  alphabetic- 
al listing  of  the  principal  uses  of  Certified  Biolog- 
ical Stains  and  Biological  Stains  supplied  by  Na- 
tional Aniline,  grouped  according  to  the  field  in 
which  the  stains  are  used. 

Since  all  biological  stains  certified  by  the  Bio- 
logical Stain  Commission  are  obtainable  from  Na- 
tional Aniline,  this  comprehensive  cross-index 
serves  as  a  reference  aid  to  the  student  of  labor- 
atory technology,  the  established  laboratory  tech- 
nician and  those  engaged  in  general  scientific  re- 
search. 

Copies  of  the  booklet.  "Biological  Stains — A 
Cross  Index,"  are  available  from  Allied  Chemical's 
National  Aniline  Division,  40  Rector  Street,  New 
York  6,  New  York. 


Mead   Johnson   Announces   New   Hay   Fever    Drug 

A  new  anti-allergic  drug  that  protects  the  user 
against  a  wide  range  of  allergic  symptoms  and 
itching  for  up  to  12  hours  on  a  single  dose  was 
announced  at  the  American  Medical  Association's 
annual    meeting   recently. 

The  new  agent  is  methdilazine  hydrochloride.  It 
was  developed  by  Mead  Johnson  &  Company  of 
Evansville,  Indiana,  and  is  being  marketed  under 
the  tradename  Tacaryl.  It  is  being  introduced  na- 
tionally simultaneously  with  the  A.M. A.  meeting 
announcement. 

Tacaryl  is  available  at  drug  stores  on  a  doctor's 
prescription.  It  is  being  marketed  as  8  mg.  scored 
tablets  in  bottles  of  100,  and  as  a  fruit-flavored 
syrup  in  16  oz.  bottles.  Usual  daily  dosage  is  one 
tablet  or  two  teaspoonfuls  of  syrup  twice  daily 
for  adults,  and  one-half  tablet  or  one  teaspoonful 
syrup  twice  daily  for  children. 


312 


NORTH  CAROLINA  MEDICAL  JOURNAL 


July.  1960 


! 


3n  ilnnonam 

William  Wills  Green,  M.D. 

William  Wills  Green  was  born  on  July  29,  1885, 
in  Franklin  County,  North  Carolina  and  was  edu- 
cated in  the  schools  of  that  community,  Horner's 
Military  Academy,  and  the  University  of  North 
Carolina,  being  graduated  in  1908.  He  began  the 
practice  of  medicine  and  surgery  in  Tarboro  in 
1910  and  remained  active  until  one  month  before 
his  death  on  March  12,  1960  The  only  interruption 
in  his  practice  was  for  service  in  the  Army  Med- 
ical Corps  in  World  War  I  with  the  rank  of  Major. 
He  was  an  active  member  of  the  County,  District, 
and  State  Medical  Societies  and  the  American 
Medical  Associaion  for  50  years,  and  was  a  past 
president  of  the  Edgecombe-Nash  Medical  Society. 
He  was  a  member  of  the  American  College  of  Sur- 
geons. He  was  an  active  member  of  the  Howard 
Memorial  Presbyterian  Church  of  Tarboro  and  the 
Tarboro    Rotary   Club. 

The  death  of  Dr.  Green  has  removed  from  us 
one  of  our  most  beloved  and  outstanding  citizens. 
He  loved  people  and  in  turn  was  loved  by  them. 
One  had  only  to  view  the  great  mass  of  flowers 
and  the  crowd  at  his  final  rites  to  know  that  here 
indeed  was  a  friend  of  man. 

Dr.  Green  contributed  of  his  time  and  talents  in 
many  ways  for  the  betterment  of  Tarboro  and 
Edgecombe  Couny.  Not  only  did  he  give  of  his 
outstanding  professional  skill  to  all,  without  re- 
gard to  color  or  creed,  social  or  financial  standing, 
but  he  was  always  ready  to  help  with  anything 
that  represented  improvement  and  advancement  for 
his  fellow  man.  For  25  years  he  was  chairman  of 
the  Edgecombe  County  Board  of  Education  and  un- 
doubtedly to  him  goes  a  large  share  of  the  credit 
for  our  splendid  school  system  He  worked  tire- 
lessly to  raise  money  for  improvement  of  the  phy- 
sical equipment  and  lived  to  realize  his  dream  of 
seeing  the  one-room  school  house  replaced  by 
modern    schools. 

Several  years  ago  when  it  became  apparent  that 
the  existing  local  hospital  facilities  were  inadequate. 
Dr.  Green  again  gave  his  time  and  ability  in  help- 
ing plan  a  new  hospital  and  worked  hard  and  long 
in  promoting  the  passage  of  a  bond  issue  neces- 
sary for  the  construction  of  the  new  Edgecombe 
General  Hospital.  For  26  years  he  was  Chief  of 
Staff  of  the  old  hospital,  a  position  he  held  in  the 
new   one   at  the   time   of  his   death. 

A  small  insight  into  the  character  of  this  truly 
great  man  can  be  gotten  from  the  fact  that  when 
the  Tarboro  Little  League  was  formed.  Dr.  Green 
assumed  the  position  of  co-chairman  of  the  finance 
committee,  and  each  year  personally  went  to  bus- 
iness firms  and  individuals  and  solicited  much  of 
the  money.  Therefore 


Be  it  resolved:  That  the  Edgecombe-Nash  Med- 
ical Society  has  lost  a  valuable  member  and  each 
of  us  a  true  friend;  and  that  we,  the  members  of 
the  Edgecombe-Nash  Medical  Society  express  our 
deep  sorrow  and  extend  sympathy  to  his  family; 
and  that  a  copy  of  these  resolutions  be  placed  in 
the  permanent  files  of  this  Society,  a  copy  be  sent 
to  his  family,  and  a  copy  be  sent  to  the  North 
Carolina   Medical   Journal. 

W.   K.  McDowell,   M.D. 

A.   C.   Norfleet,   M.D. 


The  Month  am  WasMaigtom 

(CONTINUED  FROM   PAGE  309) 

Prior  to  approving  the  Mills  plan,  the 
committee  rejected  the  Forand  bill  (three 
times)  and  the  Eisenhower  Administra- 
tion's far-reaching  public  assistance  altern- 
ative. Both  plans  were  opposed  by  the  med- 
ical profession  and  allied  groups. 

While  these  legislative  proposals  were  in 
the  limelight,  a  little-noticed  bill  was  en- 
acted into  law  to  give  $50  million  in  relief 
to  taxpayers  burdened  with  taking  care  of 
ill  dependent  parents. 

The  new  law  permits  taxpayers  full  de- 
duction on  federal  income  taxes  for  medical 
and  dental  expenses  paid  for  a  dependent 
parent  65  years  of  age  and  older.  Previous- 
ly, such  a  deduction  was  limited  to  costs  in 
excess  of  three  per  cent  of  the  taxpayer's 
adjusted  gross  income. 

Changes  in  the  Social  Security  program 
called  for  in  the  catch-all  bill  approved  by 
the  Ways  and  Means  Committee   would : 

1.  Eliminate  the  requirement  that  a  dis- 
abled person  must  be  at  least  50  years  old 
to  be  eligible  for  Social  Security  benefits. 

2.  Provide  Social  Security  benefits  for 
about  25,000  widows  of  workers  who  died 
before  1940. 

3.  Increase  the  benefits  of  400,000  surviv- 
ing children  of  workers  covered  by  Social 
Security. 

Although  all  these  revisions  will  increase 
costs  of  the  program,  neither  the  Social 
Security  tax  rate  nor  tax  base  was  in- 
creased. 

The  revisions  will  mark  the  fifth  conse- 
cutive year  of  a  national  election  that  the 
Social  Security  program,  originally  enacted 
in  1935,  has  been  expanded.  Some  of  the 
expansions  have  been  accompanied  by  tax 
increases. 


when  you  see 
signs  of 
anxiety-tension 

specify 


dihydrochloride 


brand  of  thiopropazate  dihydrochloride 

for  rapid  relief  of  anxiety  manifestations 


■"  2?  *  */*  * 


You  will  find  Dartal  outstandingly  beneficial 
in  management  of  the  anxiety -tension  states 
so  frequent  in  hypertensive  or  menopausal 
patients.  And  Dartal  is  particularly  useful 
in  the  treatment  of  anxiety  associated  with 
cardiovascular  or  gastrointestinal  disease,  or 
the  tension  experienced  by  the  obese  patient 
on  restricted  diet.  You  can  expect  consistent 
results  with  Dartal  in  general  office  practice. 


with  low  dosage:  Only  one  2,  5  or  10  mg.  tablet 
t.i.d.  with  relative  safety:  Evidence  indicates  Dartal 
is  not  icterogenic. 

Clinical  reports  on  Dartal:  1.  Edisen,  C.  B.,  and  Samuels, 
A.  S.:  A.M.A.  Arch.  Neurol.  &  Psychiat.  80:481  (Oct.)  1958. 

2.  Ferrand,   P.  T.:   Minnesota  Med.  41:853   (Dec.)    1958. 

3.  Mathews,  F.  P.:  Am.  J.  Psychiat.  114:1034  (May)  1958. 


SEARLE 


v : 


XXXVI 


NORTH  CAROLINA  MEDICAL  JOURNAL 


July,  1900 


m 


whenever  there  is  inflammation, 
swelling,  pain 

VARIDASE 

6TREirrOKINASE-STREPTOOOBNA3E   LEOEOLE 

BUCCAL™^ 

conditions  for  a 
fast  comeback . . . 


5  days  of  classic  therapy         after  48  hours  of  VARIDASE 

as  in  cellulitis* 

Until  Varidase  stemmed  infection, 
inflammation,  swelling  and  pain,  neithe- 
medication  nor  incision  and  drainage 
had  affected  the  increasing  cellulitis. 

Varidase  mobilizes  the  natural  healing 
process,  by  accelerating  fibrinolysis,  to 
condition  the  patient  for  successful  primary 
therapy.  Increases  the  penetrability  of  the 
fibrin  wall,  for  easy  access  by  antibodies 
and  drugs .  .  .  without  destroying  limiting 
membrane  .  .  .  and  limits  infiltration. 
Prescribe  Varidase  Buccal  Tablets  routinely 
in  infection  or  injury. 

*lnnerfield.  I.:   Clinical  report  cited  with  permission. 

Varidase  Buccal  Tablets  contain: 

10.OIIO  Units  Streptokinase,  2.">00  Units  Streptodornase. 

Supplied:  Boxes  of  24  and  100  tablets 

LEDERLE   LABORATORIES, 

A  Division  of  American  Cyanamid  Company,  Pearl  River,  N.  Y. 


July,  1960 


ADVERTISEMENTS 


XXXVII 


AN  AMES  CLINIQUICr 

CLINICAL  BRIEFS  FOR  MODERN  PRACTICE 


'-• 


WHAT 

LABORATORY 

PROCEDURES 

ARE  INDICATED  IN 

DIABETICS  WITH 

URINARY  TRACT 

INFECTIONS? 


A  urine  culture  is  absolutely  essential  in  the  diabetic  suspected  of  having  a  urinary  tract  infec- 
tion since  such  infection  is  not  always  accompanied  by  pyuria.  It  is  also  essential  to  keep  the 
urine  free  from  sugar— as  shown  by  frequent  urine-sugar  tests— for  successful  therapy. 

Source:  Harrison,  T.  R.,  el  at.:  Principles  of  Internal  Medicine,  ed.  3,  New  York,  McGraw-Hill  Book  Co.,  1958,  p.  620. 


the  most  effective  method  of  routine  testing  for  glycosuria, 
color-calibrated 


L  i ITEST 

«""">  Reagent  Tablets 

the  standardized  urine-sugar  test  for  reliable  quantitative  estimations 

Urinary  tract  infections  are  about  four  times  more  frequent  in  the  diabetic  than  in 
the  non-diabetic.  The  prevention  and  treatment  of  urinary  tract  infections,  as  well  as 
the  avoidance  of  other  complications  of  diabetes,  are  significantly  more  effective  in  the 
well-controlled  diabetic.  The  patient  should  be  impressed  repeatedly  with  the  importance 
of  continued  daily  urine-sugar  testing— especially  during  intercurrent  illness— and  warned 
of  the  consequences  of  relaxed  vigilance. 

"lirine-SUgar  profile"   With  the   new   Graphic  Analysis  Record  included  in  the  Clinitest 

Urine-Sugar  Analysis  Set  (and  in  the  tablet  refills),  daily  urine-sugar  readings  may  be  recorded  to 
form  a  graphic  portrayal  of  glucose  excretion  most  useful  in  clinical  control.  ^^^^^eaaeo 

•  motivates  patient  cooperation  through  everyday  use  of  Analysis  Record 

•  reveals  at  a  glance  day-to-day  trends  and  degree  of  control 

•  provides  a  standardized  color  scale  with  a  complete  range  in  the  familiar  blue-to 
orange  spectrum 


guard  against  ketoacidosis 

...test  for  ketonuria 

for  patient  and  physician  use 


ADDED  SAFETY  FOR  DIABETIC  CHILDREN 

ACETESF     KET0STIX@ 

Reagent  Tablets  Reagent  Stripy 


AMES 

COMPANY.    INC 

Elkhart  •  Indiana 
Toronto  •  Canada 


f  A? 


XXXVIII 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July,  1960 


The  choice  of  confidence... 


diagnostic  x-ray  equipment 
planned  for  private  practice! 


Few  who  purchase  x-ray  equipment  have 
time  to  thoroughly  test  the  quality  of  mate- 
rials, workmanship  and  technical  perform- 
ance offered  by  all  the  makes  of  x-ray  units. 
And  happily  this  is  not  necessary. 

The  manufacturer's  reputation  is  worth 
more  than  anything  else  to  you  in  choosing 
x-ray  equipment,  one  of  the  most  complex 
professional  investments  you  will  ever  face. 

General  Electric  has  created  "just  what 
the  doctor  ordered"  in  the  200-ma  Patrician, 
in  terms  of  both  reasonable  cost  and  operat- 
ing qualities.  Here  diagnostic  x-ray  is  ideally 


tailored  to  private  practice.  Patrician  pro- 
vides everything  you  need  for  radiography 
and  fluoroscopy  —  and  with  consistent  end 
results,  since  precise  radiographic  calibration 
is  as  much  a  part  of  the  Patrician  combina- 
tion as  it  is  of  our  most  elaborate  installa- 
tions. For  complete  details  contact  your  G-E 
x-ray  representative  listed  below. 

Thgress  Is  Our  Most  Important  Product 

general!!  electric 


Direct   Factory   Branch 
CHARLOTTE 

1140  Elizabeth   Ave. 
FR  6-1531 


NORTH   CAROLINA 

Resident    Representatives 
WILSON 

A.    L.   Harvey 

1501   Branch  St.     •     Phone  23   7-2440 

WINSTON-SALEM 

N.  E.   Bolick 
1218  Miller  St.    •    Phone  PArk  4-5864 


July,  1960 


ADVERTISEMENTS 


XXXIX 


Ar 

the  i(| 
site    1 

of 

—      .,                                      :    , 

Following  determination 
of  basal  secretion, 
intragastric  pH  was 
continuously  determined 
by  means  of  frequent 
readings  over  a 
two-hour  period. 


peptic 
ulcer 


PH  Data  based  on  pH  measurements  in  11  patients  with  peptic  ulcer1 


1.5 


Neutralization 
with  standard 
aluminum  hydroxide 


neutralization 
is  much 
faster  and 
twice 
as  long 
with 


60 


Ma"  CREAMALIN  AN1BC,° 


LABORATORIES  ! 
New  York  18,  N.  Y, 


TABLETS 


New  proof  in  vivo"  of  the  much  greater  efficacy  of  new  Creamalin 
tablets  over  standard  aluminum  hydroxide  has  now  been  ob- 
tained. Results  of  comparative  tests  on  patients  with  peptic  ulcer, 
measured  by  an  intragastric  pH  electrode,  show  that  newCreamalin 
neutralizes  acid  from  40  to  65  per  cent  faster  than  the  standard 
preparation.  This  neutralization  (pH  3.5  or  above)  is  maintained 
for  approximately  one  hour  longer. 

New  Creamalin  provides  virtually  the  same  effects  as  a  liquid 
antacid2  with  the  convenience  of  a  tablet. 
Nonconstipating  and  pleasant-tasting,  new  Creamalin  antacid 
tablets  will  not  produce  "acid  rebound"  or  alkalosis. 
Each  new  Creamalin  antacid  tablet  contains  320  mg.  of  specially 
processed,  highly  reactive,  short  polymer  dried  aluminum  hy- 
droxide gel  (stabilized  with  hexitol)  with  75  mg.  of  magnesium 
hydroxide.  Minute  particles  of  the  powder  offer  a  vastly  increased 
surface  area  for  quicker  and  more  complete  acid  neutralization. 

Dosage:  Gastric  hyperacidity -from  2  to  4  tablets  as  necessary.  Peptic 
ulcer  or  gastritis  -  from  2  to  4  tablets  every  two  to  four  hours.  Tablets  may 
be  chewed  swallowed  whole  with  water  or  milk,  or  allowed  to  dissolve 
in  the  mouth.  How  supplied:  Bottles  of  50,  100,  200  and  1000. 
1.  Data  in  the  files  of  the  Department  of  Medical  Research,  Winthrop 
Laboratories.  2.  Hinkel,  E.  T.,  Jr.;  Fisher,  M.  P.,  and  Tainter,  M.  L.:  J.  Am. 
Pharm.  A.  (Sclent.  Ed.)  48:384,  July,  1959. 

for  peptic  ulcer  Hgastritis  ■gastric  hyperacidity 


XL 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July.    l''-0 


Diagnostic 

Quandaries 

Colitis?      Gall  Bladder  Disease? 

Chronic  Appendicitis  ? 

Rheumatoid  A  rthritis  ?      Regional  Enteritis  ? 


W  Wi  DISEASE  that  is  frequently 
■  A  V  overlooked  in  solving  diag- 
"fll  '  nostic  quandaries  is  amebiasis. 
■■Hi1  Its  symptoms  are  varied  and 
contradictory,  and  diagnosis  is  extremely 
difficult.  In  one  study,  56%  of  the  cases 
would  have  been  overlooked  if  the  routine 
three  stool  specimens  had  been  relied  on.1 

Another  study  found  96%  of  a  group 
of  150  patients  with  rheumatoid  arthritis 
were  infected  by  E.  histolytica.  In  15  of 
these  subjects,  nine  stool  specimens  were 
required  to  establish  the  diagnosis.2 

Webster  discovered  amebic  infection  in 
147  cases  with  prior  diagnoses  of  spastic 
colon,  psychoneurosis,  gall  bladder  dis- 
ease, nervous  indigestion,  chronic  appen- 
dicitis, and  other  diseases.  Duration  of 
symptoms  varied  from  one  week  to  over 
30  years.  In  some  cases,  it  took  as  many 
as  six  stool  specimens  to  establish  the 
diagnosis  of  amebiasis.3 

Now  treatment  with  Glarubin  provides 
a  means  of  differential  diagnosis  in  sus- 
pected cases  of  amebiasis.  Glarubin,  a 
crystalline  glycoside  obtained  from  the 
fruit  of  Simarouba  glauca,  is  a  safe,  effec- 
tive amebicide.  It  contains  no  arsenic, 
bismuth,  or  iodine.  Its  virtual  freedom 
from  toxicity  makes  it  practical  to  treat 


suspected  cases  without  undertaking  dif- 
ficult, and  frequently  undependable,  stool 
analyses.  Marked  improvement  following 
administration  of  Glarubin  indicates  path- 
ologically significant  amebic  infection. 

Glarubin  is  administered  orally  in  tablet 
form  and  does  not  require  strict  medical 
supervision  or  hospitalization.  Extensive 
clinical  trials  prove  it  highly  effective  in 
intestinal  amebiasis. 

Glarubin* 

TABLETS 

specific  for  intestinal  amebiasis 

Supplied  in  bottles  of  40  tablets,  each 
tablet  containing  50  mg.  of  glaucarubin. 

Write  for  descriptive  literature,  bibli- 
ography, and  dosage  schedules. 

!.  Cook,  JE.,  P-riccs,  C.  \V  ,  and  Hlndley.  F.W.:  Chronic  Ame- 
bfasis  and  Ihe  Need  Tor  a  Diagnostic  Prolile.  Am.  Pract  and  Die 
ol  Treat.  ff:1821  (Dec  ,  1955). 

2.  Rlnehart,  K.  E„  and  Marcus,  H  :  Incidence  of  Amebiasis  in 
Healthy  Individuals,  clinic  Patients  and  Tliose  with  Rheumatoid 
Arthritis.  Northwest  Med..  o^:70S  (July,  1955). 

3.  Webster.  B.H.:  Amebiasis,  a  Disease  of  Multiple  Manifesta- 
tions. Am.  Pract.  and  Dig.  of  Treat.  S:S97  (June.  195S). 

•U.S.  Pat.  N8.  2.S64.745 

THE  S.E.  |y|ASSENGILL   COMPANY 


NEW  YORK 


BRISTOL,  TENNESSEE 
KANSAS  CITY 


SAN    FRANCISCO 


July,  1960 


ADVERTISEMENTS 


IN  CONTRACEPTION... 


XLI 
~1 


WHY  IS  SPEEDIER  SPERMICIDAL  ACTION  IMPORTANT? 

Because  a  swift-acting  spermicide  best  meets  the  variables  of  spermatozoan  activity. 


Lanesta  Gel,  ". . .  found  to  immobilize  human  sper- 
matozoa in  one-third  to  one-eighth  the  time  required 
by  five  of  the  leading  contraceptive  products  currently 
available  .  .  ."*  thus  provides  the  extra  margin  of 
assurance  in  conception  control.  The  accelerated 
action  of  Lanesta  Gel  —  it  kills  sperm  in  minutes  in- 
stead of  hours  — may  well  mean  the  difference 
between  success  and  failure. 

•Berberian,  D.  A.,  and  Slighter,  R.  G.:  JAMA.  168:2257 
(Dec.  27)  1958. 

In  Lanesta  Gel  7 -chloro-4-indanol,  a  new,  effective, 
nonirritating,  nonallergenic  spermicide  produces  im- 
mediate immobilization  of  spermatozoa  in  dilution 
of  up  to  1:4,000.  Spermicidal  action  is  greatly  accel- 


erated by  the  addition  of  10%  NaCl  in  ionic  form. 
Ricinoleic  acid  facilitates  the  rapid  inactivation  and 
immobilization  of  spermatozoa  and  sodium  lauryl 
sulfate  acts  as  a  dispersing  agent  and  spermicidal 
detergent. 

Lanesta  Gel  with  a  diaphragm  provides  one  of  the 
most  effective  means  of  conception  control. 
However,  whether  used  with  or  without  a 
diaphragm,  the  patient  and  you,  doctor,  can 
be  certain  that  Lanesta  Gel  provides  .faster 
spermicidal  action  —  plus  essential  diffusion 
and  retention  of  the  spermicidal  agents  in 
a  position  where  they  can  act  upon  the 
spermatozoa. 


t-ii 

■  .  . 


Lanesta  Gel 

Supplied:  Lanesta  Exquiset  .  .  .  with  diaphragm  of  prescribed  size  and  type;  universal  introducer;  \  f^  DfOdllCt 

Lanesta  Gel,  3  oz.  tube,  with  easy  clean  applicator,  in  an  attractive  purse.  Lanesta  Gel,  3  oz.  tube  with  ]  x  I  antefin® 

applicator;  3  oz.  refill  tube  —  available  at  all  pharmacies.  ;  , 

Manufactured  by  Esta  Medical  Laboratories,  Inc.,  Alliance,  Ohio  Distributed  by  George  A,  Breon  &  Co.,  New  York  18,  N  Y.  <,...  "  :  . 


XLII 


NORTH  CAROLINA   MEDICAL  JOURNAL 


July,   l'.-'O 


I 


J 


no  irritating  crystals  •  uniform  concentration  in  each  drop" 
STERILE  OPHTHALMIC  SOLUTION 

NEO  HYDELTRASOL 


2,000    TIMES    MORE    SOLUBLE    THAN 

"The  solution  of  prednisolone  has  the 

advantage  over  the  suspension  in  that  no 

crystalline  residue  is  left  in  the  patient's 

cul-de-sac  or  in  his  lashes  ....  The  other 

advantage  is  that  the  patient  does  not  have  to 

shake  the  drops  and  is  therefore  sure  of 

receiving  a  consistent  dosage  in  each  drop."2 


PREDNISOLONE   2\- PHOSPHATE-NEOMYCIN  SULFATE 

PREDNISOLONE    OR     HYDROCORTISONE 

1.  Lippmann.  0.:  Arch   Ophth.  57:339.  March  1957. 

2.  Gordon,  D.M.:  Am.  J.  Ophth.  46:740.  November  1958. 
supplied:  0.5%  Sterile  Ophthalmic  Solution  NEO- 
HYDELTRASOL  (with  neomycin  sulfate)  and  0.5%  Sterile 
Ophthalmic  Solution  HYDELTRASOL'.    In  5  cc.  and  2.5  cc 
dropper  vials   Also  available  as  0.25%  Ophthalmic 
Ointment  NEO-HYDELTRASOL  (with  neomycin  sulfate) 
and  0.25%  Ophthalmic  Ointment  HYDELTRASOL. 
In  3.5  Gm.  tubes 


HYDELTRASOL  and  NEO-HYDELTRASOL  are  trademarks  of  Merck  S  Co..  Inc. 
^m    MERCK  SHARP  &  DOHME    Division  of  Merck  &  Co,  Inc..  Philadelphia  1.  Pa. 


XLIII 


ORIGINAL    FORMULA 

The  ideal  cerebral  tonic  and  stimulant  for  the  aged. 


NICOZOL  therapy  (the  original  formula)  affords 
prompt  relief  of  apathy.  Patients  generally  look 
better,  feel   better;   become  more  cooperative, 
cheerful  and  easier  to  manage. 
No  dangerous  side  effects. 


NICOZOL  contains  pentylenetetrazol 
and  nicotinic  acid 

For  relief  of  agitation  and  hostility: 
NICOZOL  with  reserpine  Tablets 

Supply:  Capsules  •  Elixir 


Write  for  professional  sample  and  literature. 


see 
Page  666 


DRUG 

C^jj^ff^f^   WINSTON-SALEM    1,    NORTH    CAROLINA 


XLIV 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July,  1960 


l'AGrs.  Ea. 
FLAVORED 


I 

Living  up  to 
a  family  tradition 


There  are  probably  certain  medications  which  are 
special  favorites  of  yours,  medications  in  which 
you  have  a  particular  confidence. 

Physicians,  through  ever  increasing  recommen- 
dation, have  long  demonstrated  their  confidence 
in  the  uniformity,  potency  and  purity  of  Bayer 
Aspirin,  the  world's  first  aspirin. 

And  like  Bayer  Aspirin,  Bayer  Aspirin  for  Chil- 
dren is  quality  controlled.  No  other  maker  submits 
aspirin  to  such  thorough  quality  controls  as  does 
Bayer.  This  assures  uniform  excellence  in  both 
forms  of  Bayer  Aspirin. 

You  can  depend  on  Bayer  Aspirin  for  Children 
for  it  has  been  conscientiously  formulated  to  be 
the  best  tasting  aspirin  ever  made  and  to  live  up 
to  the  Bayer  family  tradition  of  providing  the  finest 
aspirin  the  world  has  ever  known. 

Bayer  Aspirin  for  Children- IVi  grain  flavored 
tablets-Supplied  in  bottles  of  50. 

•  We  welcome  your  requests  for  samples  on  Bayer 
Aspirin  and  Flavored  Bayer  Aspirin  for  Children. 


GRIP-TIGHT  CAP 
for  Children's 
Greater  Protection 


""•mix  "wi  m*V* 

W  BAYER 

11        ASPIRIN   \ 

^CHILDREN 


THE    BAYER    COMPANY.    DIVISION     OF    STERLING    QRUG     INC..  1450    BROADWAY.    NEW    YORK    18.    N.  Y. 


July,  1960 


ADVERTISEMENTS 


XLV 


in  arthritis  and  allied 
disorders 

Butazolidin" 

brand  of  phenylbutazone 

Geigy 

Since  its  anti-inflammatory  properties 
were  first  noted  in  Geigy  laboratories  10 
years  ago,  time  and  experience  have 
steadily  fortified  the  position  of 
Butazolidin  as  a  leading  nonhormonal 
anti-arthritic  agent.  Indicated  in. both 
chronic  and  acute  forms  of  arthritis, 
Butazolidin  is  noted  for  its  striking 
effectiveness  in  relieving  pain, 
increasing  mobility  and  halting 
inflammatory  change. 

Proved  by  a  Decade  of  Experience 
Confirmed  by  1700  Published  Reports 
Attested  by  World-Wide  Usage 

Butazolidin®,  brand  of  phenylbutazone: 
Red,  sugar-coated  tablets  of  100  mg. 
Butazolidin®  Alka:  Orange  and  white 
capsules  containing  Butazolidin  100  mg.; 
dried  aluminum  hydroxide  gel  100  mg.; 
magnesium  trisilicate  150  mg.; 
homatropine  methylbromide  1.25  mg, 

Geigy,  Ardsley,  New  York                         wjgf 

-• '  'ffllBPBK'flnPtiiFr*i  ^t.. 

1   wA      ""*"-  -^      :/*m^m 

^\           \j 

162-60 


XLVI 


NORTH   CAROLINA  MEDICAL  JOURNAL 


July,   I960 


\ 


. 


for  treatment  of 


Peptic  Ulcers 
and  Hyperacidity 


Brand     of     Hyamagnate 


... 


Neutralizes  excess  acidity 
Sustains  acid-base  balance 


Glycamine    Is    a    New    Chemical    Compound 

—  not  a  mixture  of  alkalis —  that  re-establishes  nor- 
mal digestion  without  affecting  enzymatic  activity. 
Glycamine's  CONTROLLED  ACTION  does  not 
stimulate  acid   secretion    or  alkalosis. 

NON-SYSTEMIC    Glycamine    is    compatible   with 
antispasmodics  and   anticholinergics. 


Pn&tiytibe 


GLYi  \>II.\E  TABLETS    \>M  I.IIM  III 

Available  in   bottles  of  lOO.  500 
and  lOOO  tablets;   or  pints. 


Loic  dosage 
prorides  prompt 
long  lasting  relief 

•  Only  four  pleasant 

tasting,  chew-up 

tablets  or  four 

teaspoonfuls  needed 

dally.  Each  dosage 

maintains  optimum 

pH  for  4'A  hours. 


PHARMACEUTICALS 


May  ran  1 1 


me. 

Greensboro,  North  Carolina 


July,  1960 


ADVERTISEMENTS 


XLVII 


HELP  US  KEEP  THE 
THINGS   WORTH    KEEPING 


It's  good  to  be  a  boy,  exploring  the 
wide  world,  soaking  up  wonderful 
new  sounds  and  sights  everywhere 
you  go.  And  if  the  world's  a  peaceful 
place,  it's  good  to  grow  up,  too,  and 
become  a  man. 

But  will  the  world  stay  peaceful? 
That  depends  on  whether  we  can  keep 
the  peace.  Peace  costs  money. 

Money  for  military  strength  and 


for  science.  And  money  saved  by 
individuals  to  help  keep  our  economy 
strong. 

Your  Savings  Bonds  make  you  a 
Partner  in  strengthening  America's 
Peace  Power. 

The  Bonds  you  buy  will  earn  good 
interest  for  you.  But  the  most  im- 
portant thing  they  earn  is  peace. 
Are  you  buying  enough? 

HELP   STRENGTHEN   AMERICA'S    PEACE    POWER 

BUY  U.  S.  SAVINGS   BONDS 

The  U.S.  Government  does  not  pay  for  this  advertising.  The  Treasury  Department  thanks 
The  Advertising  Council  and  this  magazine  for  their  patriotic  donation. 


VW 


4  1-2x6  1-2  in.     100  Screen     SBD-GM-59-12 


XLVIII 


NORTH   CAROLINA  MEDICAL  JOURNAL 


July,  1960 


A  Vacation  from  Hay  Fever 
is  a  Real  Vacation 

ANYWHERE  -  ANYTIME 

Just  a  "poof"  of  fine  nTz  spray 

brings  relief  in  seconds,  for  hours 


NlZ  is  a  potentiated,  balanced 
combination  of  these  well  known 
synergistic  compounds : 
Neo-Synephrine®  HC1,  0.5% 

-  dependable  vasoconstrictor 
and  decongestant. 

Thenfadil®  HC1,  0.1% 

-  potent  topical 
antihistaminic. 

Zephiran®  CI,  1:5000 

-  antibacterial  wetting 
agent  and  preservative. 


NASAL  SPRAY 


Supplied  in  leakproof,-^^s 

pocket  size  o^x 

squeeze  bottles  of  20  cc.  "^  ^ 


UUn/tOp   IABORATOHIES  >vj 

I     Newrotk  it.y   I.  JtM 


July,  1960 


ADVERTISEMENTS 


XLIX 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July.  19fi0 


More  mileage... 


The  older  man  in  industry  needs  the 
help  of  doctor,  management,  and  home- 
maker  ...  to  extend  his  years  of  pro- 
ductivity. 

A  recent  study  of  presumably  healthy 
men  in  business  showed  nearly  one- 
third  to  be  obese.  Many  suffered  from 
diseases  of  nutritional  origin  or  requir- 
ing special  dietary  treatment. 

Obesity  is  associated  with  increased 
incidence  of  many  serious  diseases  .  .  . 
chronic  illnesses  occurring  with  about 
twice  the  frequency  among  obese  indi- 
viduals 40  to  59  years  of  age  as  among 
those  of  normal  weight.  At  all  ages, 
more  deaths  occur  among  the  obese. 
Evidence  indicates  obesity  is  becoming 
more  frequent  among  men  .  .  .  increas- 
ing the  health  hazard  during  middle 
years. 

Mechanization  of  industry  increases 
the  value  of  the  skilled  and  experienced 
worker.  .  .while  decreasing  his  physical 
activity  and  energy  needs  .  .  .  and  in- 


creasing his  need  for  choosing  foods  of 
high  nutrient  content  in  relation  to  cal- 
orie value.  Milk  is  such  a  food. 

Three  glasses  of  milk  a  day  ...  to 
drink  .  .  used  in  food  preparation  .  .  . 
as  cheese  or  ice  cream  .  .  .  will  provide 
all  the  calcium  needs  of  men  .  .  .  and 
supply  generous  amounts  of  high  qual- 
ity protein  and  other  essential  nutrients. 

In  planning  meals  to  maintain  and 
extend  productivity  of  the  man  in 
industry,  milk  and  milk  products  are 
foundation  foods  for  good  eating  and 
good  health. 

The  nutritional  statements  made  by  this 
advertisement  have  been  revielted  by  the 
Council  on  Fo^ds  and  Nutrition  of  the  Ameri- 
can Medical  Association  and  jound  consistent 
with   current   authoritative  medical   opinion. 

S:nce  1915  .  .  .  promoting  better  health 
through  nutrition,  research  and  education. 


NATIONAL  DAIRY  COUNCIL 

A  non-profit  organization 
111  N.  Canal  Street  •  Chicago  6,  111. 


THIS  ADVERTISEMENT  IS  ONE  OF  A  SERIES.  REPRINTS  ARE  AVAILABLE  UPON  REQUEST 


This   information    is    reproduced    in    the    interest   of    good    nutrition    and    health    by    the    Dairy 

Council  Units  in  North   Carolina. 

Burlington-Durham-Raleigh 

310   Health  Center  Bldg. 
Durham.   N.  C. 


High  Point-Greensboro 
106  E.  Northwood  St. 
Greensboro,  N.  C. 


Winston-Salem 
610  Coliseum  Drive 
Winston-Salem,  N.  C. 


July,  1960 


ADVERTISEMENTS 


LI 


51to49...it'saboy! 


94  to  6  BONADOXIN'stops  morning  sickness 


When  she  asks  "Doctor,  what  will  it 
be?"  you  can  either  flip  a  coin  or  point 
out  that  51.25%  births  are  male.1  But 
when  she  mentions  morning  sickness, 
your  course  is  clear:  bonadoxin. 

For,  in  a  series  of  766  cases  of  morning 
sickness,  seven  investigators  report  ex- 
cellent to  good  results  in  94 %.2  More 
than  60  million  of  these  tiny  tablets 
have  been  taken.  The  formula:  25  mg. 
Meclizine  HC1  (for  antinauseant  ac- 
tion) and  50  mg.  Pyridoxine  HC1  (for 


metabolic  replacement).  Just  one  tablet 
the  night  before  is  usually  enough. 

bonadoxin  — drops  and  Tablets— are 
also  effective  in  infant  colic,  motion 
sickness,  labyrinthitis,  Meniere's  syn- 
drome and  for  relieving  the  nausea  and 
vomiting  associated  with  anesthesia  and 
radiation  sickness.  See  pdr  p.  795. 

1.  Projection  from  Vital  Statistics,  U.S.  Govern- 
ment Dept.  HEW,  Vol.  48,  No.  14,  1958,  p.  398. 

2.  Modell.  W. :  Drugs  of  Choice  1958-1959,  St.  Louis, 
C.  V.  Mosby  Company,  1958,  p.  347, 


New  York  17,  New  York 
Division.  Chas.  Pfizer  &  Co.,  Inc. 
Science  for  the  World's  Well-Being 


LII 


NORTH  CAROLINA  MEDICAL  JOURNAL 


July,  1960 


"TMh 


whenever  depression 
complicates  the  picture 


In  many  seemingly  mild  physical  disorders 
an  element  of  depression  plays  an 
insidious  etiologic  or  complicating  role. 

Because  of  its  efficacy  as  an  antidepres- 
sant, coupled  with  its  simplicity  of  usage, 
Tofranil  is  admirably  adapted  to  use  in  the 
home  or  office  in  these  milder  "depression- 
complicated"  cases. 


Tofranil 

brand  of  imipramine  HCI 


hastens  recovery 


Geigy 


It  is  always  wise  to  recognize  that  depres- 
sion may  be  an  underlying  factor... that 
Tofranil  may  speed  recovery  in  "hypochon- 
driasis"; in  convalescence  when  recovery 
is  inexplicably  prolonged;  in  chronic  illness 
with  dejection;  in  the  menopausal  patient 
whose  emotional  disturbances  resist 
hormone  therapy;  and  in  many  other  com- 
parable situations  in  which  latent  depres- 
sion may  play  a  part. 

Detailed  Literature  Available  on  Request. 

Tofranil*,  brand  of  imipramine  hydrochloride, 
tablets  of  25  mg.  Ampuls  for  intramuscular 
administration,  25  mg.  in  2  cc.  of  solution. 


160-60 


Geigy,  Ardsley,  New  York 


July,  1960  ADVERTISEMENTS LIH 


I  Major  Hospital  Policy 

Pays  up  to  $10,000.00  for  each  member  of  your  family, 
subject  to  deductible  you  choose 

Deductible  Plans  available: 
$100.00 
$300.00 
I  $500.00 


1 


: 


Business  Expense  Policy 

Covers  your  office  overhead   while   you 
are  disabled,  up  to  $1,000.00   per  month 


Write  or  Call 
for  information 

Ralph  ].  Golden  Insurance  Agency 


Phones:   BRoadway  5-3400      BRoadway  5-5035 


I 
i. 


i  j  l  I 

approved  by  I 

I 
The  Medical  Society  of  North  Carolina 

for  Its  Members 


| 

I 

ivaipn  ).  ooiueii  insurance  regency 

f     Ralph  J.  Golden  Associates  Henry  Maclin,  IV     | 

I     Harry  L.  Smith  John  Carson 

I 

108   East  Northwood  Street 

Across  Street  from  Cone   Hospital 

GREENSBORO,  N.  C. 


1 


MM 


LIV 


NORTH  CAROLINA   MEDICAL  JOURNAL 


July,  1960 


whenever  digitalis 
is  indicated 


LANOXIN  DIGOXIN 


formerly  known  as  Digoxin  'B.  W.  &  Co. 


v    tnlis  assent  were 
"If  one  digital  ag 

Ko  recommended  jor  us 

,  Levine.S-  A'                             2J,  par.  Z- 
Boston.  U"«-  


'LANOXIN'  TABLETS 
0.25  mg.  scored  (white) 
0.5  mg.  scored  (green) 


■M 


'LANOXIN'  INJECTION 
0.5  mg.  in  2  cc.  (I.M.  or  I.V.) 


'LANOXIN'  ELIXIR  PEDIATRIC 

0.05  mg.  in  1  cc. 


URROUGHS  WELLCOME  &  CO.  (U.S.A.)  INC.,  Tuckahoe,  N.Y. 


July,  1960 


ADVERTISEMENTS 


LV 


How  to  be 
Carefree 
Without 
Hardly 
Trying  •  •  • 


It  really  takes  a  load  off  your  mind.  .  . 
to  know  that  you  are  protected  from 
loss  of  income  due  to  illness  or  accident! 

"Dr.  Carefree"  has  no  30-day 
sick  leave  ...  no  Workmen's 
Compensation  . . .  BUT  he   has  a 
modern  emergency  INCOME  PROTEC- 
TION PLAN  with  Mutual  of  Omaha. 

When  he  is  totally  disabled  by  accident  or  sickness  covered  by  this  plan,  this  plan 
will  give  him  emergency  income,  free  of  Federal  income  tax,  eliminating  the  night- 
mare caused  by  a  long  disability. 

Thousands  of  members  of  the  Medical  Profession  are  protected  with  Mutual  of  Oma- 
ha's PROFESSIONAL  MEN'S  PLAN,  especially  designed  to  meet  the  needs  of  the 
profession. 

If  you  do  not  already  own  a  Mutual  of  Omaha  INCOME  PROTECTION  PLAN,  get  in 
touch  now  with  the  nearest  General  Agent,  listed  below.  You'll  get  full  details,  with- 
out obligation. 


m 

OF  OMAHj 

Largest  Exclusive  Health  and  Accident  Company  in  the  World. 


G.  A.  RICHARDSON,  General  Agent 
Winston-Salem,  N.  C. 


J.  A.  MORAN,  General  Agent 
Wilmington,  N.  C. 

J.  P.  GILES,  General  Agent 
Asheville,  N.  C. 


LVI 


NORTH  CAROLINA   MEDICAL  JOURNAL 


July,   1960 


TUCKER    HOSPITAL,   Inc. 

212  West  Franklin  Street 
Richmond,  Virginia 

A  private  hospital  for  diagnosis  and  treatment  of  psychiatric  and  neurol- 
ogical patients. 
Hospital  and  out-patient  services. 

(Organic  diseases  of  the  nervous  system,  psychoneuroses,  psychosomatic 
disorders,  mood  disturbances,  social  adjustment  problems,  involutional 
reactions  and  selective  psychotic  and  alcoholic  problems.) 


Dk.  James  Asa  Shield 


Dr.  Weir  M.  Tucker 


Dr.  George  S.  Fultz 


Dr.  Amelia  G.  Wood 


Protection  Against  Loss  of  Income 
from  Accident  &  Sickness  as  Well  as 
Hospital  Expense  Benefits  for  You  and 
All  Your  Eligible  Dependents 


All 


PREMIU  MS 


COME    FRO** 


PHYSICIANS 
SURGEONS 
DENTISTS 


All 


BENE  FITS 


60   TO 


PHYSICIANS    CASUALTY    &    HEALTH 
ASSOCIATIONS 

OMAHA   31,    NEBRASKA 
Since      1902 

Jandsome  Professional  Appointment  Book  sent   to 
you   FREE   upon   request. 


Compliments  of 

WachtePs,  Inc* 

SURGICAL 
SUPPLIES 


65  Haywood  Street 

ASHEVILLE,  North  Carolina 
P.  O.  Box   1716      Telephone  3-7616—3-7617 


July,  1960 


ADVERTISEMENTS 


LVII 


..*^,f*?bs*  • 


V  Convalescence 

1-' 


fant  diarrhea 


Old  age 


Whenever 
the  diet  is  faulty, 
the  appetite  poor, 
or  the  loss  of  food 
is  excessive 

through  vomiting 
or  diarrhea — 

Valentine's 

MEAT  EXTRACT 


stimulates  the  appetite, 

increases  the  flow  of 
digestive  juices, 

provides:  supplementary 
amounts  of  vitamins,  minerals 
and  soluble  proteins, 

extra-dietary  vitamin  Bu, 

protective  quantities  of 
%    potassium,  in  a  palatable  and 
;  4,  readily  assimilated  form. 


.Postoperatively 


Debilitating 
gastrointestinal 

conditions 


Supplied  in  bottles  of  2  or  6  fluidouncti. 

Dosage  is  1  teaspoonful  two  or  three  times 
daily;  two  or  three  times  this  amount  for 
Potassium  therapy. 

VALENTINE  Company,  Inc. 

RICHMOND  21,  VIRGINIA 


Of  special  x~Cjf 

significance 

to  the  -—V 

physician         /~r 

is  the  symbol  I'  ':•, 

When  he  sees  it  engraved 
on  a  Tablet  of  Quinidine  Sulfate 

he  has  the  assurance  that 

the  Quinidine  Sulfate  is  produced 

from  Cinchona  Bark,  is  alkaloidally 

standardized,  and  therefore  of 

unvarying  activity  and  quality.     . 

When  the  physician  writes  "DR" 
(Davies,  Rose)  on  his  prescriptions 
for  Tablets  Quinidine  Sulfate,  he  is 

assured  that  this  "quality"  tablet 
is  dispensed  to  his  patient. 

Rx  Tablets  Quinidine  Sulfate  Natural 

0.2  Gram  (or  3  grains) 

Davies,  Rose 

Clinical  samples  sent  to  physicians  on  request 

Davies,  Rose  St  Company,  Limited 
Boston  18,  Mass.   .. 


LVIII 


NORTH   CAROLINA  MEDICAL  JOURNAL 


July.  1960 


O-way  support 

for  the 

aging  patient... 


ASSISTS  PROTEIN  UPTAKE 
IMPROVES  MENTAL  OUTLOOK 
AIDS  NUTRITIONAL  INTAKE 


N 


® 


Geriatric  Vitamins-Minerals-Hormones-d-Amphetamine  lederle 


Each  capsule  contains:  Ethinyl  Estradiol  0.01  mg.  •  Methyl 
Testosterone  2.5  mg.  •  d-Amphetamine  Sulfate  2.5  mg.  •  Vitamin 
A  (Acetate)  5,000  U.S. P.  Units  •  Vitamin  D  500  U.S. P.  Units  • 
Vitamin  B„  with  AUTRINIC"'  Intrinsic  Factor  Concentrate  1/15 
U.S.P.  Unit  (Oral)  •  Thiamine  Mononitrate  (B.l  5  mg.  •  Ribo- 
flavin (B2)  5  mg.  •  Niacinamide  15  mg.  •  Pyridoxine  HCI  (B6) 
0.5  mg.  •  Calcium  Pantothenate  5  mg.  •  Folic  Acid  0.4  mg.  • 
Choline  Bitartrate  25  mg.  •   Inositol  25  mg.  •  Ascorbic  Acid  (C) 


as  Calcium  Ascorbate  50  mg.  •  l-Lysine  Monohydrochloride 
25  mg.  •  Vitamin  E  (Tocopherol  Acid  Succinate)  10  Int.  Units  • 
Rutin  12.5  mg.  •  Ferrous  Fumarate  (Elemental  iron.  10  mg.) 
30.4  mg.  •  Iodine  (as  Kl)  0.1  mg.  •  Calcium  (as  CaHP04)  35  mg. 
•  Phosphorus  (as  CaHP0d)  27  mg,  ■  Fluorine  (as  CaFj)  0.1  mg.  • 
Copper  (as  CuO)  1  mg.  •  Potassium  (as  K,S04)  5  mg.  •  Manganese 
(as  MnO;l  1  mg.  •  Zinc  (as  ZnO)  0.5  mg.  •  Magnesium  (MgO) 
1  mg.  •  Boron  (as  NaAOj.lOHiO)  0.1  mg.  Bottles  of  100,  1000. 


LEDERLE  LABORATORIES,  a  Division  of  AMERICAN  CYANAMID  COMPANY,  Pearl  River,  New  York 


Come  to  Mt.  Pisgah  and  be  tranquillized 
by  nature.  Rustic  inn  &  cottages  perched 
high  on  slope  in  National  Forest  near 
Asheville.  Heavenly  quiet.  Cool.  Over- 
looks glorious  Great  South  View.  Exhil- 
arating air,  superb  food.  Refuge  and 
restorative  for  tired  doctors.  May  1-Oct. 
31. 

Write 

PISGAH  FOREST  INN 

Candler,   N.  C.   Rr.    1,   Box   433 


STOP 

CLIMBING 

STAIRS 


Avoid 

Heart  Strain 

and  Fatigue 

with  a 

Home  Elevator 


Inclin-ator  travels  up  and  down 
stairways — Elevette  fits  snugly 
into  closet  space.  Ideal  for  in- 
valids and  older  folks,  with  safe 
push-button  controls.  Uses  or- 
dinary house  current.  Used  in 
hundreds  of  nearby  homes.  Call 
or  write  today  for  free  survey. 


ELEVATORS 

Freight  &  Passenger  Elevators 

Greensboro,  North  Carolina 

Charlotte    t    Raleigh 

Roanoke    •    Augusta    •    Greenville 


July.   1960 


ADVERTISEMENTS 


LIX 


e 

f 

«     o 

1 

\ 

For  Prevention  and  Reversal  of 

Cardiac  Arrest 

The  Birtcher  Mobile  Cardiac  Monitoring  and  Re- 
suscitation Center* 


Cardiac  Arrest  is  an  ever  present  danger  during 
anesthesia 


Cardiac  arrest  can  occur  during  an  anesthesia,  even  to 
patients  with  no  prior  record  of  cardiac  disease.  Contin- 
uous monitoring  of  every  patient  can  prevent  most 
cardiac  arrests  by  providing  advance  warning.  For  cases 
where  the  accident  cannot  be  prevented,  instruments  to 
reverse  the  arrest  and  restore  circulation  should  always 
be  instantly  available. 

*CompTised  of  the  Birtcher  Cardioscope,  EEG  Pre-Amplifier,  Dual 
Trace  Electronic  Switch,  Electrocardiograph,  Defibrillator  and  Heart- 
pacer    icith    all    necessary    attachments    on    a    Mobile    Stand    as    shou-n. 

Carolina  Surgical  Supply  Company 


"The    House    of    Friendly    and    Dependable    Service" 

06    TUCKER   ST.  TEL:    TEMPLE    3-8631 

RALEIGH.    NORTH    CAROLINA 


SAINT    ALBANS 

PSYCHIATRIC      HOSPITAL 

(A    Non-Profit   Organization) 

Radford,    Virginia 


James  P. 
Daniel  D.  Chiles,  M.  D. 

Clinical  Director 
James  K.  Morrow,  M.  D. 
Silas  R.   Beatty,  M.   D. 


STAFF 

King,  M.   D.,   Director 

William  D.  Keck,  M.  D. 
Edward  W.  Gamble,  III,  M. 
J.  William  Giesen,  M.  D. 
Internist  (Consultant) 


Clinical  Psychology: 

Thomas  C.  Camp,  Ph.  D. 
Artie  L.  Sturgeon,  Ph.  D. 


Don  Phillips 
Administrator 


AFFILIATED  CLINICS 


Bluefield  Mental  Health  Center 

525  Bland  St.,  Bluefield,  W.  Va. 

David  M.  Wayne,  M.   D. 

Phone:    DAvenport   5-9159 

Charleston  Mental  Health  Center 

1119  Virginia  St.,  E.,  Charleston,  W.  Va. 

B.   B.  Young,  M.  D. 

Phone:    Dickens  6-7691 


Beckley  Mental  Health  Center 

109  E.  Main  Street,  Beckley,  W.  Va 

W.  E.  Wilkinson,  M.  D. 

Phone:  CLifford   3-8397 

Norton  Mental  Health  Clinic 

Norton  Community   Hospital,   Norton 
Pierce  D.  Nelson,  M.  D. 
Phone:  218,  Ext.  55  and  56 


Va. 


LX 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July.  1960 


BRAWNER'S  SANITARIUM,  INC, 

(Established  1910) 
2932  South  Atlanta  Road,  Smyrna,  Georgia 


FOR   THE   TREATMENT   OF   PSYCHIATRIC    ILLNESSES 
AND   PROBLEMS  OF  ADDICTION 

MODERN      FACI  LITI  ES 

Approved  by  Central  Inspection  Board  of  American  Psychiatric  Association 
and  the  Joint  Committee  on  Accreditation 

Jas.  N.  Brawner,  Jr.,  M.D. 
Medical  Director 

Phone  HEmlock  5-4486 


HIGHLAND   HOSPITAL,  INC. 

Founded  In  1904 

ASHEVILLE,  NORTH   CAROLINA 

Affiliated  with  Duke  University 


A    non-profit   psychiatric   institution,    offering    modern    diagnostic    and    treatment    procedures — insulin,    electroshock,    psy- 
chotherapy,   occupational    and    recreational    therapy — for    nervous    and    mental    disorders. 

The  Hospital   is   located   in   a   75-acre   park,   amid   the  scenic   beauties  of  the   Smoky  Mountain   Range  of   Western   North 
Carolina,   affording   exceptional   opportunity   for   physical    and    emotional    rehabilitation. 

The    OUT-PATIENT    CLINIC    offers    diagnostic    service    and    therapeutic     treatment     for    selected     case    desiring    non- 
resident   care. 


R.  CHARMAN  CARROLL,  M.D. 
Medical   Director 


ROBERT    L.    CRAIG,    M.D. 
Associate    Medical    Director 


JOHN    D.    PATTON,    M.D. 
Clinical    Director 


July,  1960 


ADVERTISEMENTS 


LXI 


ASHEVILLE 


APPALACHIAN     HALL 

ESTABLISHED  —  1916 


NORTH  CAROLINA 


An    Institution    for   the    diagnosis    and    treatment    of    Psychiatric    and    Neurological    illnesses,    rest,    convalescence,    drug 

and  alcohol   habituation. 

Insulin    Coma,     Electroshock    and     Psychotherapy     are    employed.    The   Institution    is   eauipped    with    complete  laboratory 

facilities    including     electroencephalography     and     X-ray. 

Appalachian    Hall    is    located    in    Asheville,    North    Carolina,   a    resort   town,   wnich    justly   claims    an   all    around    climate 

for   health   and   comfort.    There    are   ample    facilities    for   classification   of   patients,    rooms   single   or   en   suite. 

Wm.  Ray  Griffin,  Jr.,  M.D. 
Robert  A.  Griffin,  M.D. 


For  rates  and  further  information  write 


Mark  A.  Griffin,  Sr.,  M.D. 
Mark  A.  Griffin,  Jr.,  M.D. 

APPALACHIAN    HALL,    ASHEVILLE,    N.    C. 


When  too  many  tasks 

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the  unyielding  hours, 

a  welcome 

"pause  that  refreshes" 

with  ice-cold  Coca-Cola 

often  puts  things 

into  manageable  order. 


LXII 


NORTH   CAROLINA   MEDICAL  JOURNAL 


July,  19(50 


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A  brightens  the  outlook 
▲  lightens  the  load  of 

poor  nutrition 
A  heightens  tissue/ 

hone  metabolism 


Geriatric  Vitamins-Minerals-Hormones-d-Amphetamine  Lederle 


Each  capsule  contains:  Ethinyl  Estradiol  0.01  mg.  •  Methyl 
Testosterone  2.5  mg.  •  d-Amphetamine  Sulfate  2.5  mg.  •  Vitamin 
A  (Acetate)  5,000  U.S. P.  Units  •  Vitamin  D  500  U.S.P.  Units  • 
Vitamin  B,2  with  AUTRINIC ?  Intrinsic  Factor  Concentrate  1  15 
U.S.P.  Unit  (Oral)  •  Thiamine  Mononitrate  (B,)  5  mg.  •  Ribo- 
flavin (B2)  5  mg.  •  Niacinamide  15  mg.  •  Pyridoxine  HCI  (B6) 
0.5  mg.  •  Calcium  Pantothenate  5  mg.  •  Folic  Acid  0.4  mg.  • 
Choline  Bitartrate  25  mg.  •  Inositol  25  mg.  •  Ascorbic  Acid  (C) 


as  Calcium  Ascorbate  50  mg.  •  l-Lysine  Monohydrochloride 
25  mg.  •  Vitamin  E  (Tocopherol  Acid  Succinate)  10  Int.  Units  • 
Rutin  12.5  mg.  •  Ferrous  Fumarate  (Elemental  iron,  10  mg.) 
30.4  mg.  •  Iodine  (as  Kl)  0.1  mg.  •  Calcium  (as  CaHPOJ  35  mg. 
•  Phosphorus  (as  CaHPO.,)  27  mg.  •  Fluorine  (as  CaF,)  0.1  mg.  • 
Copper  (as  CuOi  1  mg.  •  Potassium  (as  K;S04)  5  mg.  •  Manganese 
(as  MnO;)  1  mg,  •  Zinc  (as  ZnO)  0.5  mg.  ■  Magnesium  (MgO) 
1  mg.  •  Boron  (as  Na2B.,0,.10H;0i  0.1  mg.  Bottles  of  100,  1000. 


LEDERLE  LABORATORIES,  a  Division  of  AMERICAN   CYANAMID   COMPANY,   Pearl   River,   New  York 


July,  1960 


ADVERTISEMENTS 


LXIII 


INDEX  TO  ADVERTISERS 


American    Casualty    Insurance    Company LIII 

Ames    Company    ..XXXVII 

Appalachian    Hall     LXI 

Arnar-Stone    Laboratories    XXIII 

Ayerst    Laboratories     XXVII 

Brawner's    Sanitarium    LX 

Brayten    Pharmaceutical    Company    IX 

George   A.    Breon   XLI 

Bristol  Laboratories XII,   XIII,  XVIII,   XXIV, 

XXV,  XXVIII 
Burroughs-Welleome   &   Company   XXII,   LIV 

Carolina    Surgical    Supply    Co LIX 

Coca   Cola  Bottling  Company   LXI 

Columbus    Pharmacal    Company    XLIX 

J.    L.    Crumpton    XXXIV 

Dairy   Council   of   North   Carolina    L 

Davies,   Rose  &   Co LVII 

Drug   Specialties,   Inc.   XLIII 

Endo    Laboratories    XX 

Geigy    Pharmaceutical   XLV,    LII 

General    Electric    X-Ray   Dept XXXVIII 

Glenbrook  Laboratories   (Bayer  Co.)    XLIV 

Highland    Hospital     LX 

Hospital  Saving  Assn.  of  N.  C XXXI 

Jones   and  Vaughan,  Inc Ill 

Lederle   Laboratories    XXI,   XXVI,   XXXII, 

XXXIII,  XXXVI,   LVIII,  LXII 
Eli  Lilly  &  Company  XXX,  Front  Cover 


The  S.  E.  Massengill   Company  XL 

May  rand,    Inc XLVI 

Merck,   Sharp  &   Dohme   ...  Second   Cover,  XLII 

Monarch   Elevator   and   Machine   Co LVIII 

Mutual    of   Omaha   LV 

Parke,  Davis  &  Co LXIV,  Third  Cover 

Physicians  Casualty  Association 

Physicians    Health    Association    LVI 

Physicians   Products    Company   XIV 

Pinebluff    Sanitarium    I 

Pisgah    Forest   Inn    LVIII 

P.   Lorillard   Company    (Kent   Cigarettes)    XI 

A.   H.   Robins   Company   XV 

J.  B.   Roerig  &   Company  XIX,   LI 

Saint   Albans    Sanatorium    LIX 

Schering    Corporation    XXIX 

G.  D.   Searle  &  Co XXXV 

Smith-Dorsey    Company    XVI,    XVII 

Smith-Kline   &   French   Laboratories   4th   Cover 

St.  Paul  Fire  and  Marine  Insurance LXIII 

Tucker    Hospital     LVI 

U.    S.    Vitamin    Company    Reading 

Valentine    Company    LVII 

Wachtel's    Incorporated    LVI 

Wallace   Laboratories   VI,    Insert,  VII 

Wesson   Oil  and   Snowdrift 

Sales    Company   IV,   V 

Winchester  Surgical  Supply  Co. 

Winchester-Ritch    Co.    I 

Winthrop   Laboratories    X,   XXXIX,   XLVIII 


Ury    • 


CHOSEN    BY  MEDICAL 
SOCIETY  OF  THE  STATE  OF 
NORTH    CAROLINA   FOR 
PROFESSIONAL 
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for  your  complete  insurance  needs  .  .  . 

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THERE  IS  A  SAINT  PAUL  AGENT  IN  YOUR 
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Head  Office 
412   Addison   Building 
Charlotte,    North   Carolina 
EDison   2-1633 


HOME    OFFICE:    385    WASHINGTON    ST.,  ST.   PAUL,   MINN. 


SERVICE   OFFICE:   RALEIGH,  NORTH    CAROLINA— 323    W.    MORGAN   ST.    TEmple   4-7458 


one  child  has  epilepsy... 

even  her  companions  might  not  know— if 
her  seizures  are  controlled  with  medication 


DILANTIN 


"...nowadays  our  approach  should  be,  as  far  as  possible,  to  protect 
the  patient  with  sufficient  medicine  and  allow  him  to  live  as  much 
as  possible  the  life  of  a  normal  child."1  Under  proper  medical  care, 
epileptic  children  may  — and  should  -  participate  in  the  general  phys- 
ical activities  of  their  normal  playmates.- 
for  clinically  proved  results  in  control  of  seizures 

i>  SODIUM  KAPSEALS®  outstanding  performance 
in  grand  mal  and  psychomotor  seizures:" In 
the  last  15  years  new  anticonvulsant  agents 
have  come  into  clinical  use  but  they  have 
not  replaced  diphenylhydantoin  [Dilantin]  as  the  most  effective  single  agent 
for  a  variety  of  reasons."1  DILANTIN  Sodium  {diphenylhydantoin  sodium. 
Parke-Davis)  is  available  in  several  forms  including  Kapseals  of  0.03  Gm. 
and  of  0.1  Gm..  in  bottles  of  100  and  1.000. 

other  members  of  THE  PARKE-DAVIS  FAMILY  OF  ANTICONVULSANTS 

for  grand  mal  and  psychomotor  seizures:  PHELANTIN*  Kapseals  (Dilantin 
100  mg.,  phenobarbital  30  nig.,  desoxyephedrine  hydrochloride  2.5  mg.), 
bottles  of  100' for  the  petit  mal  triad:  MiLONTiNri  Kapseals,  (phensuximide, 
Parke-Davis)  0.5  Gm.,  bottles  of  100  and  1,000;  Suspension,  250  mg.  per 
4  cc.,  16-ounce  bottles.  CELONTIN®  Kapseals  (methsuximide,  Parke-Davis) 
0.3  Gm.,  bottles  of  100. 

Literature  supplying  details  of  dosage  and  administration  available  on  request . 
Bibliography:  (1)  Scott,  J.  S..  &  Kellaway,  P:  M.  Clin.  North  America  42:416  (March)  1958. 
(2)  Ganoui?,  L.  D.,  in  Green.  J.  R.,  &  Steelman,  H.  E:  Epileptic  Seizures.  Baltimore,  Williams  & 
Wilkins  Company.  1956,  pp.  98-102.  (3)  Bray,  P  E:  Pediatrics  23:151.  1959.  26.»o 


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IN  ANXIETY-RELAXATION 
RATHER  THAN   DROWSINESS 


STELAZINF 


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'Stelazine'  has  little  if  any  soporific  effect.  ".  .  .  pa- 
tients who  reported  drowsiness  as  a  side  effect 
mentioned  that  they  did  not  fall  asleep  when  they 
lay  down  tor  a  daytime  nap.  It  is  quite  possible  that, 
in  some  instances,  'drowsiness'  was  contused  with 
unfamiliar  feelings  of  relaxation."1 

Available' tor  use  in  everyday  practice:  Tablets, 
1  ing.,  in  bottles  of  50  and  500;  and  2  mg.,  in 
bottles  of  50. 

N.B.:  For  information  on  dosage,  side  effects, 
cautions  and  contraindications,  sec  available  com- 
prehensive literature,  PDR,  or  your  S.K.F.  rep- 
resentative. 


1.  Goddard.  E.S. :  in  Trifluoperazine.  Further  Clini- 
cal and  Laboratory  Studies,  Philadelphia,  Lea  & 
Febiger,  1959. 


SMITH 
KLINE  & 
FRENCH 


leaders  in  psychopharmacettlkal  research 


NORTH  CAROLINA 


IN  THIS  ISSUE: 


RF€Fn/£D 


SYMPOSIUM  ON  ACUTE  SURGICAL  CONDITION%  3  ,  ,R 

OF  THE  ABDOMEN  n,..lr, 

^lth" 3,0N  OF 


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Pyronil® 15  mg. 

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Clopane*  Hydrochloride  .  .  12.5  mg. 

a  sympathomimetic 
Usual  Dosage:  2  or  3  Pulvules  daily.  Also  available  as  Suspension  and  Pediatric  Pulvules. 


Co-Pyronil®  (pyrrobutamine  compound,  Lilly) 

Histadyl®  (thenylpyramine,  Lilly) 

Pyronil®  (oyrrobutamine.  Lilly) 

Clopane®  Hydrochloride  (cyclopentamine  hydrochloride,  Lilly) 

ELI   LILLY  AND  COMPANY     .     INDIANAPOLIS  6,   INDIANA,  U.  S.  A. 


Sfey 


Table  of  Contents,  Page  II 


CLINICAL  REMISSION 

IN  A  "PROBLEM"  ARTHRITIC 

In  rheumatoid  arthritis  with  diabetes  mellitus.  A  54-year-old  diabetic 
with  a  four-year  history  of  arthritis  was  started  on  Decadron,  0.75  mg./ 
day,  to  control  severe  symptoms.  After  a  year  of  therapy  with  0.5  to 
1.5  mg.  daily  doses  of  Decadron,  she  has  had  no  side  effects  and  dia- 
betes has  not  been  exacerbated.  She  is  in  clinical  remission.* 

New  convenient  b.  i.d.  alternate  dosage  schedule:  the  degree  and  extent  of  relief  provided  by 
DECADRON  allows  tor  b.i.d.  maintenance  dosage  in  many  patients  with  so-called  "chronic"  condi- 
tions. Acute  manifestations  should  first  be  brought  under  control  with  a  t.i.d.  or  q.i.d.  schedule. 

Supplied:  As  0.75  mg.  and  0.5  mg.  scored,  pentagon-shaped  tablets  in  bottles  of  100.  Also  available 
as  Injection  DECADRON  Phosphate.  Additional  information  on  DECADRON  is  available  to  physicians 
on  request.  DECADRON  is  a  trademark  of  Merck  &  Co.,  Inc. 

•From  a  clinical  investigator's  report  to  Merck  Sharp  &  Dohme. 


Decadron* 


Dexamethasone 


TREATS  MORE  PATIENTS  MORE  EFFECTIVELY 

(ffsra     MERCK  SHARP  &  DOHME  •   Division  of  Merck  &  Co.,  INC.,  West  Point,  Pa. 


I  i 


T' 


KlPSrj 


LK 


<; 


-.j 


August,  1960 


ADVERTISEMENTS 


A  Sanitarium  for   Rest   Under  Medical   Supervision,  and   Treatment   of   Nervous 
and  Mental  Diseases,  Alcoholism  and  Drug   Addiction. 

The  Pinebluff  Sanitarium  is  situated  in  the  sandhills  of  North  Carolina  in  a  60-acre  park 
of  long  pines.  It  is  located  on  U.  S.  Route  1,  six  miles  south  of  Pinehurst  and  Southern 
Pines.    This    section    is    unexcelled    for    its    healthful    climate. 

Ample  facilities  are  afforded  for  recreational  and  occupational  therapy,  particularly  out- 
of-doors. 

Special  stress  is  laid  on  psychotherapy.  An  effort  is  made  to  help  the  patient  arrive  at 
an  understanding  of  his  problems  and  by  adjustment  to  his  personality  difficulties  or 
modification  of  personality  traits  to  effect  a  cure  or  improvement  in  the  disease.  Two  resident 
physicians    and    a    limited    number    of    patients    afford    individual    treatment    in    each    case. 

For    further    information    write: 

The  Pineblu££  Sanitarium,  PinebiuSf,  N.  c. 


Malcolm  D.  Kemp,  M.D. 


Medical  Director 


RITTER ...  the  finest  for 


the  profession! 


The  Ritter  Universal  Table  enables  you  to  treat  more 
patients  more  thoroughly,  with  less  effort  in  less  time. 
Here  is  the  ultimate  in  examining  table  flexibility  .  .  . 
easy    to    position  .  .  .  more    comfortable    for    patients. 


The  L-F  BasalMeter  of- 
fers fast,  accurate  BMR 
testing.  No  graph,  chart 
or  slide  rule  needed. 
Patient's  BM  rate  is 
read     directly    on     meter. 


WINCHESTER 

"CAROLINAS'    HOUSE    OF    SERVICE" 

WINCHESTER   SURGIICAL   SUPPLY   CO.  WINCHESTER-RITCH    SURGICAL    CO. 

119  East  7th  Street  Charlotte,   N.   C.  421  West  Smith  St.       Greensboro,  N.  C. 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,   1960 


North  Carolina  Medical  Journal 

Official  Organ  of 
The  Medical  Society  of  the  State  of  North  Carolina 


Volume   21 
Number   8 


AUGUST,   1960 


75    CENTS     A    COPY 
$5.00    A    YEAR 


CONTENT 


Original  Articles 

Symposium  on  Acute  Surgical  Conditions  of 
the  Abdomen 

Acute  Abdominal  Pain  Associated  with 
Vascular  Emergencies  —  Gordon  M.  Car- 
ver,   Jr.,    M.D 313 

Diagnosis  and  Treatment  of  Intussuscep- 
tion in  Infants  and  Children  —  Louis 
Shaffner,     M.D 318 

Diagnosis  and  Treatment  of  Acute  Diver- 
ticular Disease  of  the  Colon — E.  Jackson 
Dunning,     M.D 322 

Diagnosis  and  Treatment  of  Acute  Chole- 
cystitis—William   W.    Shingleton,    M.D.      .     326 

Acute  Surgical  Conditions  Associated  with 
Pelvic  Endometriosis — Robert  A.  Ross, 
M.D 329 

Medical  and  Hospital  Costs  of  the  Aged — A 
Current    Appraisal  —  Walter    Polmer,    Ph.D.     330 

Leptospirosis:  Report  of  a  Case — William  A. 
Leonard,    Jr.,    M.D 339 

Medical  Problems  Facing  Congress — Sam  J. 
Ervin,    Jr 335 

Salmonella  and  Shigella  Infections  Found  in 
One  Hundred  Ninety-five  Cases  of  Acute 
Diarrhea— E.  R.  Caldwell,  Jr.,  and  E.  A. 
Abernathy,    M.D 342 

EDITORIALS 

Naming    New    Drugs 343 

The   Arthritis    Hoax 344 

Psychiatric   Patients    in    a    General    Hospital    .  344 

Three     Corrections 344 

Dr.   Preston — New  Editor  of  Health   Bulletin   .  345 

"You    Are    Old,    Father    William" 345 

North  Carolina's  Committee  on  the  Medical 
Credit    Bureaus 345 


COMMITTEES  AND   ORGANIZATIONS 

North   Carolina   Board   of   Medical    Examiners: 
The    Biennial    Registration 346 

Bulletin  Board 

Coming     Meetings        346 

New   Members   of   the    State   Society   ....     347 

News    Notes    from    the    University    of    North 
Carolina   School    of   Medicine 347 

News    Notes    from    the    Bowman    Gray   School 
of  Medicine  of  Wake   Forest  College   .     .     .     348 

News  Notes  from  the  Duke   Uuniversity   Med- 
ical    Center 349 

North  Carolina   Academy   of   General    Practice  349 

County    Societies 349 

News     Notes       350 

Announcements        350 

Book  Reviews 

354 

The  Month  in  Washington 

355 

In  Memoriam 

356 

Classified  Advertisements 

354 

Index  to  Advertisers 

LI 


Entered    as    second-class    matter    January    2.    1940,    at    the    Post   Office   at   Winston-Salem,    North    Carolina,    under    the    Act    of 
August  24.    1912.   Copyright   1960   by   the   Medical    Society   of   the   State   of   North    Carolina. 


v*^-i-:>^-t;/,r^;^:-^; 


(SYRUP   OF  CHLORAL 


HYDRATE  ) 


A  palatable  chloral  hydrate  syrup 
containing  10  grains  in  each  teaspoonful. 


JONES  and  VAUGHAN 
Richmond  26,  Virginia 


Another 
significant  statement 

concerning 
the  role  of  fats 


L^f 


FREE:  Wesson  recipes,  available  in  quantity  for  your  patients,  show  how  to 

prepare  meats,  seafoods,  vegetables,  salads  and  desserts  with  po/y-unsaturated 
vegetable  oil   Request  quantity  needed  from  The  Wesson  People, 

Dept.  N,  210  Baronne  St.,  New  Orleans  12,  La. 


Dietary  Linoleic  Acid  and  Linoleate— Effects  in  Diabetic  and 
Nondiabetic  Subjects  with  and  without  Vascular  Disease 


\A  paper  by  Laurance  W.  Kinsell,  M.D.,  et  al., 
{excerpted  from  Diabetes — The  Journal  of  the 
I  American  Diabetes  Association,  May-June  1959 

*' Linoleic  acid  as  the  major  'hypocholesterolemic 

\agent'  in  vegetable  fats.  The  question  has  been 

raised  as  to  the  mechanism  of  lowering  of  the 

plasma   lipids    by   a   variety   of   vegetable   fats. 

Among  the  entities  present  in  or  absent  from 

vegetable  fat  which  have  been  considered  are: 

(a)  the  absence  of  cholesterol;   (b)  the  presence 

of  certain  vegetable  sterols;  (c)  the  presence  of 

certain  vegetable  phospholipids;   (d)   the  nature 

(of  one  or  more  of  the  fatty  acids  present;   (e) 

I  the  presence  of  trace  materials. 


h  the  diet 


.. 


:The  absence  of  cholesterol  has  been  excluded  as 

I  a  major  factor.5a    Phospholipids,  if  they  contain 
la  sufficient  quantity  of  unsaturated  fatty  acids 
imay  produce  a  striking  reduction.  In  our  experi- 
ence thus  far  saturated  phospholipids  fail  to  pro- 
duce such  an  effect.7 

Beveridge  and  his  associates  believe  that  veg- 
■letable  sterols,  particularly  beta-sitosterol,  are  re- 

II  sponsible  to  a  significant  degree  for  the  cholesterol- 
||lowering  effect.8  In  our  experience  the  vegetable 

I  sterols  have  a  relatively  weak  and  unpredictable 
effect  of  this  sort. 
Since  the  fatty  acids  of  animal  fats  are  pre- 
dominantly saturated,  and  the  fatty  acids  of  most 
! vegetable  fats  are  predominantly  polyunsaturated, 
|with  linoleic  acid  as  the  major  component  of  the 
vegetable  fats  which  lower  cholesterol  and  other 
lipids,  the  question  arises  whether  linoleic  acid 
llper  se  is  capable  of  lowering  plasma  lipids.  As 
reported  previously7  this  is  indeed  the  case.  In  a 
recent  study  in   a  young  male  with   peripheral 
atherosclerosis  in  association  with  elevation  of 
plasma  cholesterol  and  of  total  lipids,  ethyl  lino- 
i  leate  produced  a  greater  fall  in  the  plasma  lipid 
|  levels   than    had   moderate   amounts   of   natural 
sources  of  unsaturated  fat.  Linoleic  acid,  there- 
fore, appears  to  be  the  most  important  single 
lipid-lowering  component  of  vegetable  fat. 
*      *      * 

Significantly  higher  levels  of  cholesterol  were 
observed  during  oleate  administration  than  dur- 
ing administration  of  equal  amounts  of  linoleate. 


The  relatively  low  cholesterol  values  during  the 
second  oleate  period  may  have  been  related  to 
linoleate  stored  in  fat  depots.  The  fatty  acid  com- 
position of  the  cholesterol  esters  reflected  the 
fat  which  was  fed,  i.e.,  the  mono-enoic+  acid 
content  averaged  more  than  40  per  cent  during 
oleate  feeding  and  less  than  20  per  cent  during 
linoleate  ingestion.  Essentially,  a  mirror  image 
of  this  resulted  during  linoleate  feeding,  at  which 
time  di-enoic  acid  predominated. 

The  data  presented  in  this  paper  appear  to  estab- 
lish that  linoleic  acid  administered  either  as  puri- 
fied ethyl  ester  or  as  naturally  occurring  fat,  in 
sufficient  quantity,  in  properly  constructed  diets, 
will  reduce  plasma  lipids  to  normal  levels.  The 
amount  of  linoleic  acid  required  appears  to  bear 
a  direct  relationship  to  the  amount  of  saturated 
fat  included  in  the  diet.  Linoleic  acid  require- 
ment may  also  bear  a  significant  relationship  to 
the  amount  of  atherosclerosis  present. 

The  transition  from  evaluation  of  the  effect  of 
dietary  entities  upon  plasma  lipids,  to  the  evalua- 
tion of  the  effect  of  such  materials  upon  vascular 
disease  is  difficult.  However,  such  evaluation  is 
not  impossible.  The  requisites  are  adequate  meas- 
uring sticks  and  well-controlled  studies  of  suffi- 
cient duration.  The  duration  of  observation  of 
effects  of  unsaturated  fat  in  diabetic  and  non- 
diabetic  patients  with  vascular  disease  is  in  no 
instance  more  than  five  years,  and  in  the  majority 
of  instances,  less  than  three.  Our  present  impres- 
sion is  that  improvement  has  occurred  in  some 
patients  with  atherosclerosis  and  with  diabetic 
retinal  and  renal  disease  which  was  more  than 
we  would  have  anticipated  in  terms  of  the  natural 
course  of  the  disease.  However,  since  it  is  well 
known  that  major  fluctuations  in  these  diseases 
can  occur  in  individuals  receiving  no  treatment, 
we  believe  it  is  appropriate  at  this  time  to  say 
that  no  untoward  effects  appear  to  result  when 
one  prescribes  diets  containing  large  amounts  of 
unsaturated  fat  for  patients  with  such  diseases, 
and  it  is  not  impossible  that  beneficial  effects  may 
be  associated  with  such  diets." 
#      »      -* 

5a  Kinsell.  L.W.,  Partridge,  J.  W.,  Boling,  L..  Margen.  S.. 
and  Michaels.  G.D.:  Dietary  modification  of  serum  cholesterol 
and  phospholipid  levels.  J.  Clin.  Endocrinol  and  Met.  12:909, 
1952. 

7  Kinsell,  L.  W.,  Friskey,  R.,  Splitter,  S..  Michaels.  G.  D. : 
Essential  fatty  acids,  lipid  metabolism,  and  atherosclerosis. 
Lancet    1:334,   1958. 

8  Beveridge,  J.M.,  Connell.  W.F.,  Firstbrook,  J.  B..  Mayer, 
G.A.,  and  Wolfe.  M.J. :  Effects  of  certain  vegetable  and  animal 
fats  on  plasma  lipids  of  humans.  J.  Nutrition   56:311,  1955. 

7  Mono-enoic  (mono-unsaturated)  acid  is  presumably  synony- 
mous under  these  conditions  with  oleic  acid  and  di-enoic  (di- 
unsaturated)    acid    with   linoleic   acid 


Where  a  vegetable  (salad)  oil  is  medically  recommended  for  a  cholesterol 
depressant  regimen,  Wesson  is  unsurpassed  by  any  readily  available  brand. 

WESSON'S      IMPORTANT     CONSTITUENTS 

Wesson  is  100%  cottonseed  oil . . .  winterized  and  of  selected  quality  Palmitic,  stearic  and  myristic  glycerides  (saturated)  25-30% 

Linoleic  acid  glycerides  (poly-unsaturated)                           50-55%  Phytosterol  (predominantly  beta  sitosterol)  0.3-0.5% 

; Oleic  acid  glycerides  (mono-unsaturated)                             16-20%  Total  tocopherols  0.09-0.12% 

Total  unsaturated  70-75%  Never  hydrogenated— completely  salt  free 


VI 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,  1960 


Carrying  on 

congestion-free 

with  fast-acting 


NASAL  SPRAY 

At  the  first  allergic  sneeze,  two  inhalations  from  the  NTz  Nasal  Spray  act  speedily  to  bring  excep- 
tional relief  of  symptoms.  The  first  spray  shrinks  the  turbinates  and  enables  the  patient  to  breathe 
through  his  nose  again.  The  second  spray,  a  few  minutes  later,  opens  sinus  ostia  for  essential 
ventilation  and  drainage.  Excessive  rhinorrhea  is  reduced.  nTz  is  well  tolerated  and  provides  safe 
"inner  space"  without  causing  chemical  harm  to  the  respiratory  tissues. 
NTz  is  a  balanced  combination  of  three  thoroughly  evaluated  compounds: 
;N  eo-Synephrine®  HCI,  0.5%  to  shrink  nasal  membranes  and  sinus  ostia  and  provide 

inner  space 
(T  henfadil®  HCI,  0.1%  to  provide  powerful  topical  antiallergic  action  and  lessen  rhinorrhea 
(Z  ephiran^1  CI,  1:5000  (antibacterial  wetting  agent  and  preservative)  to  promote  spread  and 
penetration  of  the  formula  to  less  accessible  nasal  areas 
HTzis  supplied  in  leakproof,  pocket  size,  squeeze  bottles  of  20 cc.  and  in  bottles  of  30  cc.  with  dropper. 


QUICK  SYMPTOMATIC  RELIEF  OF  HAY  FEVER  OR  PERENNIAL  RHINITIS 

nT;,  Neo-Synephrine  (brand  of  phenylephrine),  Thenfadtl  (brand  of  thenyldiamine)  and 
Zephiran  (brand  of  benzalkonium,  as  chloride,  refined),  trademarks  reg.  U.  S.   Pat.  Off. 


UljinWiob 

LABORATORIES 
New  York  18,  N.  Y. 


August,  1960 


ADVERTISEMENTS 


VII 


DIAGNOSIS 


New  (2nd)  Edition! 

Frederick  and  Towner- 
The  Office  Assistant 
in  Medical  Practice 

This  handy  manual  will  save  you  time  and 
money  in  training  an  efficient  office  assistant.  It 
is  packed  with  help  on  every  phase  of  her  job 
—  as  receptionist,  secretary,  nurse,  bookkeeper 
and  technician. 

These  are  the  kind  of  problems  on  which  your 
assistant  will  find  valuable  help:  What  should  you 
say  in  a  series  of  collection  letters?  How  do  you 
keep  a  narcotics  inventory?  What  should  you 
remember  in  preparing  the  doctor's  bag?  To 
whom  do  the  patient's  medical  records  belong? 
How  do  you  sharpen  a  hypodermic  needle? 
How  do  you  prepare  a  patient  for  pelvic  ex- 
amination? etc. 

The  authors  have  brought  this  new  edition  fully 
up-to-date.  The  chapter  on  Bookkeeping  is  ex- 
panded with  many  new  illustrations  on  the 
"write-it-once"  bookkeeping  system,  etc.  The 
chapter  on  Instruments  is  now  much  more  de- 
tailed and  clearly  illustrated.  Much  new  help  is 
added  on  sterilization. 

By  Portta  M.  Frederick,  Instructor,  Medical  Office  Assist- 
ing, Long  Beach  City  College;  and  Carol  Towner,  Director 
of  Special  Services,  Communications  Division,  American 
Medical  Association.  407  pages,  5H"  x  8",  illusttated.  S5.25. 

New  (2nd)  Edition! 


2  Companion  Volumes 

by  Paul  Williamson,  M.  D. 

Office  Diagnosis 

New!  Written  from  the  author's  long  experience 
in  general  practice,  this  book  offers  sound,  ready-to- 
use  advice  on  solving  the  family  physician's  daily 
diagnostic  problems.  With  the  help  of  simple  line 
illustrations,  Dr.  Williamson  informally  details  those 
diagnostic  techniques  that  can  be  performed  right 
in  your  own  office. 

97  important  signs  and  symptoms  are  discussed.  Be- 
ginning with  symptomatic  evidence,  the  author  takes 
you  back  to  its  possible  causes  to  help  you  arrive 
more  easily  at  a  tenable  diagnosis.  You  will  find 
symptoms  such  as  headache,  hypertension,  papular 
rash,  anorexia,  cough,  cyanosis,  heart  murmurs,  con- 
stipation, incontinence,  pain  in  the  breasts,  leu- 
korrhea  clearly  covered.  Where  pertinent,  Dr. 
Williamson  offers  definitive  help  on:  etiology,  his- 
tory taking,  general  examination  of  the  patient, 
x-ray,  laboratory  tests,  drug  therapy,  diagnostic  pit- 
falls to  avoid,  complications,  etc. 

If  you  are  familiar  with  Williamson' s  Office  Pro- 
cedures (below),  you  know  the  kind  of  useful, 
down-to-earth  help  to  expect  from  this  new  volume. 

By  Paul  Williamson,  M.D.  470  pages,  8"xll",  with  350 
illustrations.  $12.50.  New.' 


Office  Procedures 

Dr.  Williamson  fully  discusses  379  useful  manage- 
ment procedures  for  171  common  disorders  and 
diseases  in  this  unusual  book.  Aided  by  crystal  clear 
illustrations,  he  tells  you  exactly  how  to  best  proceed 
with  those  techniques  that  can  be  safely  and  effec- 
tively performed  in  your  own  office.  You  will  find 
precise  descriptions  of:  how  to  irrigate  the  ear;  how 
to  pack  for  nosebleed;  how  to  construct  and  fit  a 
truss  in  inguinal  hernia;  how  to  treat  muscle  tears 
and  ruptures;  how  to  retrieve  a  retracted  tendon; 
how  to  properly  incise  and  drain  a  breast  abscess;  etc. 

By  Paul  Williamson,  M.D.  412  pages,  8"xll",  with  1100 
illustrations.  512.50.  Published  1955. 


Order  from  W.  B.  SAUNDERS  CO M PAN Y-West  Washington  Sq.,  Phila.  5 1 


Please  send  me  the  following  books  and  charge  my  account : 

□  Williamson's  Office  Diagnosis,  $12.50        Q  Williamson'sOfficeProcedures,$12.50 
□  Frederick  &  Towner's  The  Office  Assistant,  $5.25 


Name 

Address SJG-860. 


VIII  NORTH   CAROLINA   MEDICAL  JOURNAL August,   1060 

Medical  Society  of  the  State  of  North  Carolina 

OFFICERS  —  1960 

President — Amos  Neill  Johnson,  M.D.,  Garland 

President  Elect — Claude  B.  Squires,  M.D.,  225  Hawthorne  Lane,  Charlotte 
Past  President — John  C.  Reece,  M.D.,  Grace  Hospital,  Morganton 
First  Vice-President — Theodore  S.  Raiford,  M.D.,  Doctors  Building,  Asheville 
Second  Vice-President — Charles  T.  Wilkinson,  M.D.,  Wake  Forest 
Secretary — John  S.  Rhodes,  M.D.,  700  West  Morgan  Street,  Raleigh 
Executive  Director — Mr.  James  T.  Barnes,  203  Capital  Club  Building,  Raleigh 
The   President,   Secretary   and   Executive   Director  are  members  ex-officio 

of  all  committees 
Speaker-House  of  Delegates — Donald  B.  Koonce,  M.D.,  408  N.   11th  St.,  Wilmington 
Vice-Speaker-House  of  Delegates — E.  W.  Schoenheit,  M.D.,  46  Haywood  St.,  Asheville 


COUNCILORS  —  1958  -  1961 

First  District— T.  P.  Brinn,  M.D.,  118  W.  Market  Street,  Hertford 

Vice  Councilor — Q.  E.  Cooke,  M.D.,  Murfreesboro 
Sccoyid  District — Lynwood  E.  Williams,  M.D.,  Kinston  Clinic,  Kinston 

Vice  Councilor — Ernest  W.  Larkin,  Jr.,  M.D.,  211  N.  Market  St.,  Washington 
Third  District — Dewey  H.  Bridger,  M.D.,  Bladenboro 

Vice  Councilor — William  A.  Greene,  M.D.,  104  E.  Commerce  St.,  Whiteville 
Fourth  District — Edgar  T.  Beddingfield,  Jr.,  M.D.,  P.O.  Box  137,  Stantonsburg 

Vice  Councilor — Donnie  H.  Jones,  M.D.,  Box  67,  Princeton 
Fifth  District— Ralph  B.  Garrison,  M.D.,  222  N.  Main  Street,  Hamlet 

Vice  Councilor — Harold  A.  Peck,  M.D.,  Moore  County  Hospital,  Pinehurst 
Sixth  District — George  W.  Paschal,  Jr.,  M.D.,  1110  Wake  Forest  Rd.,  Raleigh 

Vice  Councilor— Rives  W.  Taylor,  M.D.,  P.O.  Box  1191,  Oxford 
Seventh  District — 

Vice  Councilor — Edward  S.  Bivens,  M.D.,  Stanly  County  Hospital,  Albemarle 
Eighth  District— -Merle  D.  Bonner,  M.D.,  1023  N.  Elm  Street,  Greensboro 

Vice  Councilor — Harry  L.  Johnson,  M.D.,  P.O.  Box  530,  Elkin 
Ninth  District — Thomas  Lynch  Murphy,  M.D.,  116  Rutherford  St.,  Salisbury 

Vice  Councilor — Paul  McNeely  Deaton,  M.D.,  766  Hartness  St.,  Statesville 
Tenth  District — William  A.  Sams,  M.D.,  Main  Street,  Marshall 

Vice  Councilor — W.  Otis  Duck,  M.D.,  Drawer  517,  Mars  Hill 

DELEGATES  TO  THE  AMERICAN  MEDICAL  ASSOCIATION 

Elias  S.  Faison,  M.D.,  1012  Kings  Drive,  Charlotte 

C.  F.  Strosnider,  M.D.,  111  E.  Chestnut  Street,  Goldsboro 

Millard  D.  Hill,  M.D.,  15  W.  Hargett  Street,  Raleigh 

William  F.  Hollister,  M.D.,   (Alternate),  Pinehurst  Surgical  Clinic,  Pinehurst 

Joseph  F.   McGowan,  M.D.,    (Alternate),  29  Market  Street,  Asheville 

Wm.  McN.  Nicholson,  M.D.,  (Alternate),  Duke  Hospital,  Durham 

SECTION  CHAIRMEN  1959-1960 

General  Practice  of  Medicine — Julius  Sader,  M.D.,  205  East  Main  Street,  Brevard 
Internal  Medicine — Walter  Spaeth,  M.D.,  116  South  Road,  Elizabeth  City 
Ophthalmology  and  Otolaryngology — Charles  W.  Tillett,  Jr.,  M.D.,  1511  Scott 

Avenue,  Charlotte 
Surgery — James  E.  Davis,  M.D.,  1200  Broad  Street,  Durham 
Pediatrics — William  W.  Farley,  M.D.,  903  West  Peace  Street,  Raleigh 
Obstetrics  &  Gynecology — H.  Fleming  Fuller,  M.D.,  Kinston  Clinic,  Kinston 
Public  Health  and  Education — Isa  C.  GRANT,  M.D.,  Box  949,  Raleigh 
Neurology  &  Psychiatry — Myron  G.  Sandifer,  M.D.,  N.  C.  Memorial  Hospital, 

Chapel  Hill 
Radiology — Isadore  Meschan,  M.D.,  Bowman  Gray  School  of  Medicine, 

Winston-Salem 
Pathology — Roger  W.  Morrison,  M.D.,  65  Sunset  Parkway,  Asheville 
Anesthesia — Charles  E.  Whitcher,  M.D.,  Route  1,  Pfafftown 
Orthopedics  &  Traumatology — Chalmers  R.  Carr,  M.D.,  1822  Brunswick  Avenue, 

Charlotte 
Student  AM  A  Chapters — Mr.  John  Feagin,  Duke  University  School  of  Medicine, 

Durham 


\ 


Save  a 

family  breadwinner 

lost  time  from 

LOW  BACK  PAIN 

with 

TmncopaF 

Brand  of  chlormezanone 

effective  oral  skeletal 

muscle  relaxant 
and  mild  tranquilizer 


Trancopal  enables  patients 
to  resume  their  duties  in 
from  one  to  two  days. 

In  a  recent  study  of  Trancopal  in  industrial  medi- 
cine,1 results  from  treatment  with  this  "tranquil- 
axant"  were  good  to  excellent  in  182  of  220 
patients  with  muscle  spasm  or  tension  states.  From 
clinical  examination  of  those  patients  in  whom 
muscle  spasm  was  the  main  disorder,  ".  .  .  it  was 
apparent  that  the  combined  effect  of  tran- 
quilization  and  muscle  relaxation  enabled 
them  to  resume  their  normal  duties  in 
from  twenty-four  to  forty-eight  hours. 
...  It  is  our  clinical  impression  that 
Trancopal  is  the  most  effective  oral 
skeletal  muscle  relaxant  and  mild 
tranquilizer  currently  available."1 
Side  effects  occurred  in  only  12  patients,  and: 
"No  patient  required  that  the  dosage  be  reduced 
to  less  than  one  Caplet  three  times  daily  because 
of  intolerance."1 


Clinical  results  with  TvSttlCOpsJf 


Excellent 

Good 

Fair 

Poor 

Total 

,0W  BACK  SYNDROMES 

Acute  low  back  strain 

25 

19 

8 

6 

58 

Chronic  low  back  strain 

11 

5 

1 

1 

18 

"Porters'  syndrome"* 

21 

5 

1 

1 

28 

Pelvic  fractures 

2 

1 

— 

— 

3 

IECK  SYNDROMES 

Whiplash  injuries 

12 

6 

2 

1 

21 

Torticollis,  chronic 

6 

2 

3 

2 

13 

ITHER  MUSCLE  SPASM 

Spasm  related  to  trauma 

15 

6 

1 

— 

22 

Rheumatoid  arthritis 

— 

18 

2 

1 

21 

Bursitis 

2 

6 

1 

— 

9 

ENSION  STATES 

18 

2 

4 

3 

27 

OTALS 

112 
(51%) 

70 
(32%) 

23 

(10%) 

15 
(7%) 

220 

(100%) 

♦Over-reaching  in  lifting  heavy  bags  resulting  in  sprain  of  upper,  middle,  and  lower  back  muscles. 


Dosage:  Adults,  200  or  100  rag.  orally  three  or  four  times  daily. 

Relief  of  symptoms  occurs  in  from  fifteen  to  thirty  minutes  and  lasts  from  four  to  six  hours. 


How  Supplied:  Trancopal  Caplets® 

200  mg.  (green  colored,  scored),  bottles  of  100. 
100  mg.  (peach  colored,  scored),  bottles  of  100. 

1.  Kearney,  R.  D.:  Current  Therap.  Res.  2:127,  April,  1960. 


?06M  Trancopa!  (brand  of  chlormezanone)  and  Caplets,  trademarks  reg.  U.  S.  Pat.  Off. 


LABORATORIES,  New  York  1 8,  N.  Y. 


she  calls  it  "nervous  indigestion" 


diagnosis:  a  wrought-up  patient  with  a  functional 
gastro-intestinal  disorder  compounded  by  inade- 
quate digestion,  treatment:  reassurance  first,  then 
medication  to  relieve  the  gastric  symptoms,  calm 
the  emotions,  and  enhance  the  digestive  process. 
prescription:  new  Donnazyme— providing  the  mul- 
tiple actions  of  widely  accepted  Donnatals"  and 
Entozyme^— two  tablets  t.i.d.,  or  as  necessary. 


Each  Donnazyme  tablet  contains 
—In  the  gastric-soluble  outer  layer:  Hyoscyamine 
sulfate,  0.0518  mg.;  Atropine  sulfate,  0.0097  mg.; 
Hyoscine  hydrobromide,  0.0033  mg.;  Phenobarbi- 
tal  (Vs  gr.),  8.1  mg.;  and  Pepsin,  N.  F.,  150  mg. 
In  the  enteric-coated  core:  Pancreatin,  N.  F.,  300 
mg.,  and  Bile  salts,  150  mg. 

ANTISPASMODIC  -  SEDATIVE  -  DIGESTANT 


DONNAZYME 

A.     H.     ROBINS     COMPANY,     INCORPORATED     .     RICHMOND     20,     VIRGINIA 


August,  1960 


ADVERTISEMENTS 


XI 


ALL  OVER  AMERICA! 

KENT  with  the  MICRONITE  FILTER 

IS  SMOKED  BY 
MORE  SCIENTISTS  and  EDUCATORS 

than  any  other  cigarette!* 


FIVE  TOP  BRANDS  OF  CIGARETTES 
SMOKED  BY  AMERICAN  SCIENTISTS 


KENT. 

BRAND  "A" I 
BRAND  "G" ■ 
BRAND  "F" 

BRAND  "B     4 


15.3% 
10.5% 
7.9% 
7.6% 

7.3% 


\  \1 


This  does  not  constitute  a 
professional  endorsement 
of  Kent.  But  these  men,  like 
millions  of  other  Kent  smokers, 
smoke  for  pleasure,  and  choose 
their  cigarette  accordingly. 


The  rich  pleasure  of  smoking 
Kent  comes  from  the  flavor 
of  the  world's  finest  natural 
tobaccos,  and  the  free  and 
easy  draw  of  Kent's  famous 
Micronite  Filter. 


If  you  would  like  the  booklet,  "The  Story  of  Kent",  for  your 
own  use,  write  to:  P.  Lorillard  Company  — Research  De- 
partment, 200  East  42nd  Street,  New  York  17,  New  York. 


For  good  smoking  taste,  WM  [Mil? 

it  makes  good  sense  to  smoke  IrXiHINllll 


^e  Results  ol  a  continuing  sludy  of  cigarette  preferences,  conducted  oy  O'Brien  Sherwood  Associates,  N.Y..  N.Y. 
A  PRODUCT  OF  P  LORIUARD  COMPANY    FIRST  WfTW  THE  FINEST  CIGARETTES    THROUGH  LORILLARD  RESEARCH 


C  I940.F  lOniAOCCt 


XII 


NORTH  CAROLINA   MEDICAL  JOURNAL 


August,   1960 


in  respiratory  allergies 

TRISTACOMP 


Orally-administered  triple  antihistamines  plus  two  effec- 
tive decongestant  agents— to  prevent  histamine-induced 
dilatation  and  exudation  of  the  nasal  and  paranasal 
capillaries  and  to  help  contract  already  engorged  capil- 
laries, providing  welcome  relief  from  rhinorrhea,  stuffy 
noses,  sneezing  and  sinusitis. 


convenient 
dosage  forms 


TRISTACOMP  TABLETS 

Each  sustained  release  tablet: 

Chlorpheniramine   Maieafe  2.5  mg. 

Phenyjtoloxamine    Citrate  12.5  mg, 

Pyrifamine   Maleate  25.0  mg. 

Phenylephrine    Hydrochloride  10.0  mg. 

Phenylpropanolamine    Hydrochloride  30.0  mg. 

Dosage:    One    tablet    morning  and    night 

TRISTACOMP  LIQUID 

£ach    5    cc    feaspaonfu/    provides    one-fourth     the    above 

formula. 

Dosage:      Adults,    two    teaspoonfuls    three    to    four    times 

daily.    Children,    one-ha/f    to    fwo    reaspoonfy/s, 

according    fo   age. 


c  c 


jsual  medications 
act  only  here 


olief  in  MAY  FKV^ 


iSn 


NEW 


•  • 


iflSt.  - 


$»«>, 


acts  here 


to  relieve  both  nasal 


and  chest  discomfort 


M 


AV 


provides  both 


/upper 
an 


respiratory  decongestion 
and  bronchial  decongestion 


Many  hay  fever  patients  also  experience  chest  discomfort.  For  these  patients, 

new  ISOCLOR  provides  relief  along  the  entire  respiratory  tract. 

COMBINES  the  nasal  and  bronchial  decongestant  action  of  d-isoephedrine  with 

the  histamine  blocking  action  of  chlorpheniramine. 

RELIEVES  the  discomforts  of  rhinorrhea,  itching,  sneezing,  hyperlacrimation 

and  post  nasal  drip— let  s  the  patient  get  a  full  night's  rest— with  minimal  daytime 

drowsiness,  CNS  or  pressor  stimulation. 


TABLETS  AND  SYRUP  for  adults  and  children  . . . 
COMPOSITION:  Per  tablet        Per  5  ml.  syrup 

Chlorpheniramine  maleate 4  mg.  2  mg. 

d-lsoephedrine  HCI  25  mg.  12.5  mg. 

DOSE:  Tablets:  One  tablet  3  or  4  times  daily.  Syrup:  Children:  3-6  yrs. 
Vz  tsp.  t.i.d.;  6-12  yrs.  1  tsp.  t.i.d.;  Adults:  2  tsp.  t.i.d. 

AVAILABLE:  Tablets:  Bottles  of  100.  Syrup:  Pint  bottles. 


ARNAR-STONE 

Laboratories,    Inc. 
Mt.    Prospect,    Illinois 


XIV 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,   19C.0 


Naturetin 

Squibb  Benzydroflumethiazide 

NaturetincK 

Squibb  Benzydroflumethiazide  with  Potassium  Chloride 

"...a  safe  and  extraordinarily 
effective  diuretic..."1 


Naturetin  —  reliable  therapy  in  edema  and 
hypertension  —  maintains  a  favorable  uri- 
nary sodium-potassium  excretion  ratio  .  .  . 
retains  a  balanced  electrolytic  pattern: 

"...  the  increase  in  urinary  output  occurs 

promptly  . .  . " l 
"...  the  least  likely  to  invoke  a  negative 

potassium  balance  .  . ."' 
"...  a  dose  of  5  nig.  of  Naturetin  produces  a 

maximal  sodium  loss."2 
"...  an  effective  diuretic  agent  as  manifested 

by  the  loss  in  weight . . .  "3 
"...  no  apparent  influence  of  clinical 

importance  on  the  serum  electrolytes 

or  white  blood  count."3 
"...  no  untoward  reactions  were  attributed 

to  the  drug."4 
Although  Naturetin  causes  the  least  serum 
potassium  depletion  as  compared  with  other 
diuretics,  supplementary  potassium  chloride  in 
Naturetin  c  K  provides  added  protection  when 
treating  hypokalemia-prone  patients;  in  con- 
ditions where  likelihood  of  electrolyte  imbal- 
ance is  increased  or  during  extended  periods 
of  therapy. 


Numerous  clinical  studies  confirm  the  effec- 
tiveness1'1'' of  Naturetin  as  a  diuretic  and 
antihypertensive  —  usually  in  dosages  of  5 
mg.  per  day. 

■  the  most  potent  diuretic,  mg.  for  mg.— more 
than   100   times   as   potent   as   chlorothiazide 

■  prolonged  action  —  in  excess  of  18  hours  ■ 
maintains  its  efficacy  as  a  diuretic  and  anti- 
hypertensive even  after  prolonged  or  increased 
dosage  use  ■  convenient  once-a-day  dosage  — 
more  economical  for  patients  ■  low  toxicity  — 
few  side  effects— low  sodium  diets  not  necessary 

■  not  eontraindicated  except  in  complete  renal 
shutdown  ■  in  h ypertension— significant  lower- 
ing of  the  blood  pressure.  Naturetin  may  be 
used  alone  or  with  other  antihypertensive  drugs 
in  lowered  doses. 

Supplied:  Naturetin  Tablets,  5  mg.  (scored) 
and  2.5  mg.  Naturetin  cK  (5  c  500)  Tablets 
(capsule-shaped)  containing  5  mg.  benzydro- 
flumethiazide and  500  mg.  potassium  chloride. 
Naturetin  c  K  (2.5  c  500)  Tablets  (capsule- 
shaped)  containing  2.5  mg.  benzydroflumethia- 
zide and  500  mg.  potassium 
chloride.  SQUIBB 


References:  1.  David,  N.  A.:  Porter,  G.  A.,  and  Gray,  R.  H.:  Monographs  on  Therapy  S:60  (Feb.)  I960. 
2.  Stenberg-,  E.  S.,  Jr.;  Benedetti,  A.,  and  Forsham,  P.  H.:  Op.  clt.  5:46  (Feb.)  1960.  3.  Fuchs,  M.;  Moyer, 
J.  H.,  and  Newman,  B.E.:  Op.  clt.  5:55  (Feb.)  1960.  4.  Marriott.  H.  J.  L.,  and  Schamroth,  L.:  Op.  cit.  5:14 
(Feb.)  1960.  5.  Ira,  G.  H.,  Jr.;  Shaw,  D.  M.,  and  Bogdonoff,  M.  D.:  North  Carolina  M.  J.  21:19  (Jan.)  1960. 
6.  Cohen,  B.  M.:  M.  Times,  to  be  published.  7.  Breneman,  G.  M.,  and  Keyes,  J.  W.:  Henry  Ford  Hosp.  M.  Bull. 
7:281  (Dec.)  1959.  8.  Forsham,  P.  H.:  Squibb  Clin.  Res.  Notes  2:5  (Dec.)  1959.  9.  Larson,  E.:  Op.  cit.  2:10 
(Dec.)  1959.  10.  Klrkendall,  W.  M.:  Op.  clt.  2:11  (Dec.)  1959.  11.  Yu,  P.  N.:  Op.  cit.  2:12  (Dec.)  1959. 
12.  Weiss,  S.;  Weiss,  J.,  and  Weiss,  B.:  Op.  clt.  2:13  (Dec.)  1959.  13.  Moser,  M.:  Op.  cit.  2:13  (Dec.)  1959. 
14.  Kahn,  A.,  and  Greenblatt,  I.  J.:  Op.  cit.  2:15  (Dec.)  1959.  15.  Grollman,  A.:  Monographs  on  Therapy 
9:1    (Feb.)   1960.  'naturetin'  is  a  squibs  trademark. 


^..SQi  "&■  W 


Squibb  Quality— the 
Priceless  Ingredient 


PAPAIN 

IS   THE 

KEY 

to  complete,  thorough 
vaginal  cleansing 


mucolytic,  acidifying, 
ihysiologic  vaginal  douche 


The  papain  content  of  Meta  Cine  is  the  key 
•eason  why  it  effects  such  complete  cleansing  of 
he  vaginal  vault.  Papain  is  a  natural  digestant, 
md  is  capable  of  rendering  soluble  from  200- 
!00  times  its  weight  of  coagulated  egg  albumin. 
n  the  vagina,  papain  serves  to  dissolve  mucus 
jlugs  and  coagulum. 

Vteta  Cine  also  contains  lactose — to  promote 
growth  of  desirable  Doderlein  bacilli — and 
nethyl  salicylate,  eucalyptol,  menthol  and 
;hlorothymol,  to  stimulate  both  circulation  and 
normal  protective  vaginal  secretions.  Meta 
fine's  pleasant,  deodorizing,  non-medicinal  fra- 
grance will  meet  your  patients'  esthetic  demands. 

Supplied  in  4  oz.  and  8  oz.  containers,  and  in 
Doxes  of  30  individual-dose  packets.  Dosage: 
I  teaspoonfuls,  or  contents  of  1  packet,  in  2 
quarts  of  warm  water. 


EH 

:i:»\yten 


BRAYTEN    PHARMACEUTICAL   COMPANY  Chattanooga  9,  Tennessee 


XVI  NORTH   CAROLINA  MEDICAL  JOURNAL  August,   1960 


Proven 

in  over  five  years  of  clinical  use  and 
more  than  750  published  clinical  studies 

Effective 

for  relief  of  anxiety  and  tension 

Outstandingly  Safe 

•  simple  dosage  schedule  produces  rapid,  reliable 
tranquilization  without  unpredictable  excitation 

•  no  cumulative  effects,  thus  no  need  for  difficult 
dosage  readjustments 

•  does  not  produce  ataxia,  change  in  appetite  or  libido 

•  does  not  produce  depression,  Parkinson-like  symptoms, 
jaundice  or  agranulocytosis 

•  does  not  impair  mental  efficiency  or  normal  behavior 


for 

the 
tense 
and 
nervous 
patient 


Despite  the  introduction  in  recent  years  of  "new  and  dif- 
ferent" tranquilizers,  Miltown  continues,  quietly  and 
steadfastly,  to  gain  in  acceptance.  Generically  and  under 
the  various  brand  names  by  which  it  is  distributed, 
meprobamate  (Miltown)  is  prescribed  by  the  medical 
profession  more  than  any  other  tranquilizer  in  the  world. 

The  reasons  are  not  hard  to  find.  Miltown  is  a  known  drug, 
evaluated  in  more  than  750  published  clinical  reports.  Its 
few  side  effects  have  been  fully  reported;  there  are  no 
surprises  in  store  for  either  the  patient  or  the  physician. 
It  can  be  relied  upon  to  calm  anxiety  and  tension  quickly 
and  predictably. 


Usual  dosage:  One  or  two 
400  mg.  tablets  t.i.d. 
Supplied :  400  mg.  scored  tablets, 
200  mg.  sugar-coated  tablets; 
or  as  meprotabs*— 400  mg. 
unmarked,  coated  tablets. 


Miltown 


meprobamate  (Wallace} 


"  WALLACE    LABORATORIES  /  New  Brunswick,  N.  J. 


"Gratifying"  relief  from 


for  your  patients  with 
'low  back  syndrome'  and 
other  musculoskeletal  disorders 

POTENT  muscle  relaxation 
EFFECTIVE  pain  relief 
SAFE  for  prolonged  use 


stiffness  and  pain 

^IdXllyllli^     relief  from  stiffness  and  pain 

in  106-patient  controlled  study 

(as  reported  inJ.A.M.A.,  April  30,  1960) 

"Particularly  gratifying  was  the  drug's  [Soma's] 
ability  to  relax  muscular  spasm,  relieve  pain,  and 
restore  normal  movement  ...  Its  prompt  action, 
ability  to  provide  objective  and  subjective  assist- 
ance, and  freedom  from  undesirable  effects  rec- 
ommend it  for  use  as  a  muscle  relaxant  and  anal- 
gesic drug  of  great  benefit  in  the  conservative 
management  of  the  'low  back  syndrome'." 

Kestler,  O.:  Conservative  Management  of  "Low  Back  Syndrome" , 

J.A.M.A.  172:  2039  (April  30)  I960. 

FASTER  IMPROVEMENT-  79%  complete  or  marked 

improvement  in  7  days  (Kestler) 

EASY  TO  USE— Usual  adult  dose  is  one  350  mg.  tablet 
three  times  daily  and  at  bedtime. 

SUPPLIED:  350  mg.,  white  tablets,  bottles  of  50. 

For  pediatric  use,  250  mg.,  orange  capsules,  bottles  of  50. 


Literature  and  samples  on  request. 


(CARISOPRODOL,  WALLACE) 

WALLACE    LABORATORIES,    CRANBURY,    NEW   JERSEY 


9   *   V8 

?       n 


s** s  s *  s 


?« *  ?s?? 


S  8  f  t  * 
$: 
8 
8 
888  8  8888  8 
8 
8 
8 


GONORRHEA  IS  ON  THE  MARCH  AGAIN... 


a  new  timetable  for  recovery: 

only  six  capsules  of  TETREX  can  cure  a  male  patient  with  gonorrhea  in  just  one  day* 


U.S. PAT. NO.  2, 79 1,609 

THE   ORIGINAL   TETRACYCLINE    PHOSPHATE   COMPLEX 


TETREX   CAPSULES.   250   mg.   Each   capsule   contains: 
TETREX  (tetracycline  phosphate  complex  equivalent  to 
tetracycline  HCI  activity)  -  250  mg. 
DOSAGE:   Gonorrhea   in   the   male -Six   capsules  ol 
TETREX  in  3  divided  doses,  in  one  day. 

*  Marmell,  M-,  and  Prigot,  A.:  Tetracycline  phosphate  complex  in  the  treat- 
ment of  acute  qonococcal  urethritis  In  men.  Antibiotic  Med.  &  Clin.  Ther. 
6:108  (Feb.)  1959. 


BRISTOL  LABORATORIES, 

SYRACUSE.  NEW  YORK 


August,  1960  ADVERTISEMENTS  XIX 

I 


1 


Major  Hospital  Policy 

Pays  up  to  $10,000.00  for  each  member  of  your  family, 
subject  to  deductible  you  choose 


Deductible  Plans  available: 


$100.00 
$300.00 
$500.00 

! 


Business  Expense  Policy 


Covers  your  office  overhead   while   you 
are  disabled,  up  to  $1,000.00   per  month 


I 

%  approved  by 

i 

The  Medical  Society  of  North  Carolina 

|  for  Its  Members 

I 

I 

Write  or  Call 
4.  for  information 


Ralph  J.  Golden  Insurance  Agency 


I     Ralph  J.  Golden  Associates  Henry  Maclin,  IV     j 

I     Harry  L.  Smith  John  Carson  I 

I  | 

108  East  Northwood  Street 

Across  Street  from  Cone   Hospital 

GREENSBORO,  N.  C. 

Phones:    BRoadway  5-3400      BRoadway  5-5035 

I  I 


XX 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,   1960 


Squibb  Announces 


new  chemically  improved  penicillin 
which  provides  the  highest  blood 
levels  that  are  obtainable  with  oral 
penicillin  & — ^^ — m  therapy 


As  a  pioneer  and  leader  in  penicillin  therapy 
for  more  than  a  decade,  Squihb  is  pleased 
to  make  Chemipen,  a  new  .chemically  im- 
proved oral  penicillin,  available  for  clinical  use 

With  Chemipen  it  becomes  possible  as  well  as 
convenient  for  the  physician  to  achieve  and  main-     ■, 
tain  higher  blood  levels — with  greater  speed — than   \ 
those  produced  with  comparable  therapeutic  doses  of 
potassium  penicillin  V.  In  fact,  Chemipen  is  shown  to 
have  a  2:1  superiority  in  producing  peak  blood  levels 
over  potassium  penicillin  V.* 

Extreme  solubility  may  contribute  to  the  higher  blood 
levels  that  are  so  notable  with  Chemipen.*  Equally  nota- 
ble is  the  remarkable  resistance  to  acid  decomposition 
(Chemipen  is  stable  at  37CC.  at  pH  2  to  pH  3).  which 
in  turn  makes  possible  the  convenience  of  oral  treatment. 


And  the  economy  for  your  patients  will  be  of 
particular  interest — Chemipen  costs  no  more 
than  comparable  penicillin  V  preparations. 

Dosage:  Doses  of  125  mg.  (200,000  u.)  or 

250  mg.  (400.000  u. ) .  t.i.d..  depending  on  the 

severity  of  the  infection.  The  usual  precautions 

0t/     must  be  carefully  observed  with  Chemipen,  as  with 

all  penicillins.  Detailed  information  is  available  on 

request  from  the  Professional  Service  Department. 

Supply:  Chemipen  Tablets  of  125  mg.  (200.000  u.)  and 

250  mg.  (400.000  u.l,  bottles  of  24  tablets.  Chemipen 

Syrup  (cherry-mint  flavored,  nonalco-        SQUIBB 

holic  1.125  mg.  per  5  cc.  60  cc.  bottles.  ^SK 

"Knudsen.  E.  T.  and  Rolinson.  G.  N.:  ^joSf -<** 

Lancet  2.T105  (Dec. 19)  1959.  •.i'.";:,.'.'.";<i.'.<.       Pricdai  Uptiiai 


THE  ORIGINAL  potassium  phenethicillin 


TV 

^r 

V 

jar 

....> 

L  i 

~\ 


I 


J 


(POTASSIUM  PENIGILLIN-152) 


.tha 


r'i    !  ;:        \-\   ':    > 


xi  levels  orally 

intramuscular  pen 


A  dosage  form  to  meet  the  individual 
requirements  of  patients  of  all  ages  in  home, 
office,  clinic,  and  hospital: 

Syneiffin  Tablets— 250  nig. . . .  Syncillin  Tablets  - 125  mg. 
Syncillin  for  Oral  Solution— 60  ml.  bottles— when  reconstituted, 

125  nig.  per  5  ml. 
Syneillin  Pediatric  Drops  —  1 . 5  Gin .  bottles.  Calibrated  dropper 

delivers  125  nig. 


Complete  information  on  indications,  dosage  and  precautions  is  included  in  the  official  circular  accompanying  each  package. 


BRISTOL  LABORATORIES,  SYRACUSE,  NEW  YORK  {(  biustol 


THE 

REALMS 

OF  THERAPY 


PASSPORT 

TO 

TRANQUILITY 


«*?~~5>-. 


ATTAINED 
WITH 


ATA  RAX 


(brand  of  hydroxyzine) 


^ 


Special  Advantages 


unusually  safe;  tasty  syrup, 
10  mg.  tablet 


well  tolerated  by  debilitated 
patients 


useful  adjunctive  therapy  for 
asthma  and  dermatosis;  par- 
ticularly effective  in  urticaria 


\V         IN 

V  HYPEREMOTIVE 
ADULTS   £\ 

does  not  impair  mental  acuity 


Y  World-wide  record  of  effectiveness-over  200  labora- 
tory and  clinical  papers  from  14  countries. 
Widest  latitude  of  safety  and  flexibility-no  serious 
adverse  clinical  reaction  ever  documented. 
Chemically  distinct  among  tranquilizers— not  a  pheno- 
thiazine  or  a  meprobamate. 
Added  frontiers  of  usefulness— antihistaminic;  mildly 
antiarrhythmic;  does  not  stimulate  gastric  secretion. 

...and  for  additional  evidence 


Supportive  Clinical  Observation 

". . .  Atarax  appeared  to  reduce  anxiety 
and  restlessness,  improve  sleep  pat- 
terns and  make  the  child  more  amen- 
able to  the  development  of  new  pat- 
terns of  behavior. . . ."  Freedman,  A. 
M.:  Pediat.  Clin.  North  America  5:573 
(Aug.)  1958. 


". . .  seems  to  be  the  agent  of  choice 
in  patients  suffering  from  removal  dis- 
orientation, confusion,  conversion  hys- 
teria and  other  psychoneurotic  condi- 
tions occurring  in  old  age."  Smigel, 
J.  0.,  et  al.i  J.  Am.  Geriatrics  Soc. 
7:61  (Jan.)  1959. 


"All  [asthmatic]  patients  reported 
greater  calmness  and  were  able  to 
rest  and  sleep  better ...  and  led  a 
more  normal  life....  In  chronic  and 
acute  urticaria,  however,  hydroxyzine 
was  effective  as  the  sole  medica- 
ment." Santos,  I.  M.,  and  Unger,  I.: 
Presented  at  14th  Annual  Congress, 
American  College  of  Allergists,  Atlan- 
tic City,  New  Jersey,  April  23-25, 1958. 


". . .  especially  well-suited  for  ambula- 
tory neurotics  who  must  work,  drive 
a  car,  or  operate  machinery."  Ayd,  F. 
J.,  Jr.:  New  York  J.  Med.  57:1742  (May 
15)  1957. 


New  York  17,  N.Y. 

Division,  Chas.  Pfizer  &  Co.,  Inc. 

Science  for  the  World's  Well-Being 


Bayart,  J.:  Acta  paediat.  belg. 
10:164,  1956.  Ayd,  F.  J.,  Jr.:  Cal- 
ifornia Med.  87:75  (Aug.)  1957. 
Nathan,  L.  A.,  and  Andelman,  M. 
B  :  Illinois  M.  J.  112:171  (Oct.) 
1957. 


Seftel,  E.:  Am.  Pract.  &  Digest 
Treat.  8:1584  (Oct.)  1957.  Negri, 
F.:  Minerva  med.  48:607  (Feb. 
21)  1957.  Shalowitz,  M.:  Geri- 
atrics 11:312  (July)  1956. 


Eisenberg,  B.  C:  J.A.M.A.  169:14 
(Jan.  3)  1959.  Coirault,  R.,  et  al.: 
Presse  m§d.  64:2239  (Dec.  26) 
1956.  Robinson,  H.  M..  Jr.,  et  al.: 
South.  M.  J.  50:1282  (Oct.)  1957. 


^^ 


Garber,  R.  C,  Jr.:  J.  Florida  M. 
A.  45:549  (Nov.)  1958.  Menger, 
H.  C.:  New  York  J.  Med.  58:1684- 
(May  15)  1958.  Farah,  L:  Inter- 
nal. Rec.  Med.  169:379  (June) 
1956. 

SUPPLIED:  Tablets,  10  mg.,  25 
mg.,  100  mg.;  bottles  of  100. 
Syrup  (10  mg.  per  tsp.),  pint 
bottles.  Parenteral  Solution:  25 
mg./cc.  in  10  cc.  multiple-dose 
vials;  50  mg./cc.  in  2  cc.  am- 
pules. 


"\ 


J> 


NEW 

the  physician-requested  addition 
to  the  DONNAGEL  family 


Donnagel  with  paregoric  equivalent 

for  better  control  of 
acute  nonspecific 
diarrheas . . . 


This  pleasant-tasting  combination 
of  two  outstanding  antidiarrheals— 
Donnagel  and  paregoric- 
delivers  more  comprehensive  relief 
with  greater  certainty  in  acute 
self-limiting  diarrheas. 


Each  30  cc.  (1  fluidounce)  of  Donnacel-PG  contains: 


Powdered  opium  U.S.P. 

.„ 24.0  mg. 

(equivalent  to 
paregoric  6  ml.) 

Diminishes  propulsive 
contractions  and  tenes- 
mus; makes  fecal  matter 
less  liquid 


Kaolin 

.'. 6.0  Gm. 

Adsorbent  and  de- 
mulcent action 
binds  toxins  and 
irritants;  protects 
intestinal   mucosa 


Pectin 

142.8  mg. 

Demulcent  action 
complements  ef- 
fect of  kaolin 


Natural  belladonna  alkaloids 

hyoscyamine  sulfate  0.1037  mg. 

atropine  sulfate  0.0194  mg. 

hyoscine  hydrobromide  ....0.0065  mg. 

Antispasmodic  action  reduces 
intestinal  hypermotility;  mini- 
mizes the  risk  of  cramping 


Phenobarbital 

(%  gr.)  ....16.2  mg. 

Mild  sedative  ac- 
tion lessens  ten- 
sion 


Supplied:  Banana  flavored  suspension  in  bottles  of  6  fl.  oz. 

Also  available:  Donnagel®  with  Neomycin  —  for  control  of  bacterial  diarrheas. 

Donnagel®—  the  basic  formula  —  when  paregoric  or  an  antibiotic  is  not  required. 

A.  H.  ROBINS  CO.,  INC.,  Richmond  20,  Virginia 


XXIV 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,   1960 


Co-PyroniF 

keeps  most  allergic  patients 
symptom-free  around  the  clock 


Many  allergic  patients  require  only  one  Pulvule®  Co-Pyronil 
every  twelve*  hours,  because  Co-Pyronil  provides: 

•  Prolonged  antihistaminic  action 

•  Fast  antihistaminic  action 

plus 

•  Safe,  effective  sympathomimetic  therapy 

'"Unusually  severe  allergic  conditions  may  require  more  fre- 
quent administration.  Co-Pyronil  rarely  causes  sedation  and, 
even  in  high  dosage,  has  a  very  low  incidence  of  side-effects. 

Supplied  as  Pulvules,  Suspension,  and 
Pediatric  Pulvules. 

Co-Pyronil"  (pyrrobutamine  compound,  Lilly) 


ELI      LILLY      AND      COMPANY      •      INDIANAPOLIS      6,      INDIANA,      U.S.«. 


North  Carolina  Medical  Journaj 

Owned  and  Published  by 
The  Medical  Society  of  the  State  of  North  Carolina 


Volume  21 


August,  1960 


No.  8 


Symposium  on  Acute  Surgical  Conditions 

Of  the  Abdomen 

Acute  Abdominal  Pain  Associated 
With  Vascular  Emergencies 

Gordon  M.  Carver,  Jr.,  M.D. 
Durham 


Acute  abdominal  pain  of  vascular  origin 
is  still  rare  in  comparison  with  that  of  ap- 
pendicitis, peptic  ulcer,  and  cholecystitis : 
however,  as  our  population  age  increases,  ab- 
dominal vascular  emergencies  will  become 
more  frequent.  Most  of  these  vascular  le- 
sions are  of  arterial  origin-  and  the  earlier 
the  diagnosis  is  made  and  definitive  treat- 
ment instituted,  the  better  the  ultimate  re- 
sult. 

Dissecting  and  Ruptured  Abdominal 
Aortic  Aneurysms 

The  abdominal  aneurysm  may  be  relative- 
ly asymptomatic  until  it  begins  to  enlarge 
as  a  result  of  dissection.  Varying  degrees 
of  severe  pain  in  the  abdomen  or  back  then 
develops  and  is  thought  to  be  due  to  disten- 
tion and  tearing  of  the  muscular  layers  of 
the  aorta. 

The  diagnosis  of  dissecting  abdominal 
aortic  aneurysm  is  usually  quite  simple. 
Palpation  of  the  abdomen  reveals  a  pulsat- 
ing mass  which  is  often  noted  by  the  patient 
himself.  A  lateral  roentgenogram  of  the 
lumbar  spine  may  reveal  calcification  of  the 
aortic  wall  and  determine  the  diameter  of 
the  aneurysm.  Angiography  can  be  used  to 
establish  the  diagnosis  but  is  usually  not 
necessary. 

The  clinical  diagnosis  of  ruptured  abdom- 
inal aortic  aneurysm  is  made  on  the  basis  of 
.  an  acute  onset  of  abdominal  pain,  with  or 
without  shock,  and  the  presence  of  a  pulsat- 
ing mass  increasing  rapidly  in  size.    A  flat 

Presented   before   the   Section   on   Surgery,   Medical    Society 
Of  the  State  of  North  Carolina.   Raleigh,  May  10,    1960. 


plate  of  the  abdomen  may  reveal  an  obliter- 
ated psoas  shadow  as  well  as  calcification  in 
the  aneurysmal  wall.  Occasionally  the  blood 
hematacrit  and  blood  pressure  may  be  main- 
tained at  a  normal  level  for  several  hours  or 
even  days  after  rupture  of  the  aneurysm. 
The  point  of  rupture  is  most  commonly  seen 
posteriorly,  but  it  may  be  on  the  anterior 
or  lateral  surface  of  the  aorta. 

The  treatment  mortality  rate  in  elective 
resections  has  diminished  to  such  a  point 
that  it  is  sound  to  recommend  removal  of 
almost  all  abdominal  aortic  aneurysms  on 
diagnosis.  One  of  the  most  compelling  rea- 
sons for  resection  is  that  more  than  50  per 
cent  of  patients  with  ruptured  aneurysms, 
although  aware  of  the  presence  of  the  lesion, 
have  had  no  symptoms  prior  to  the  rupture. 
In  general  the  larger  the  aneurysm  the 
greater  the  probability  of  rupture.  Justifi- 
cation for  the  emphasis  on  elective  surgery 
in  these  cases  is  the  evidence  that  it  increases 
life  expectancy.  DeBakey  and  Cooley(1)  have 
shown  a  postoperative  survival  rate  of  82 
per  cent.  Wright  and  others'-1,  in  their  an- 
alysis of  the  natural  course  of  the  disease, 
found  a  steady  decline  in  survival  rates  from 
60  per  cent  at  the  end  of  one  year  to  16 
per  cent  at  the  end  of  three  years.  There 
is  of  course  little  or  no  argument  regarding 
the  immediate  indications  for  resection  of 
dissecting  or  ruptured  aortic  abdominal 
aneurysms. 

The  surgical  treatment  consists  of  excis- 
ing the  aneurysm  through  a  long  xiphoid  to 
pubic  incision,  replacing  the  excised  segment 


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NORTH   CAROLINA   MEDICAL  JOURNAL 


August,  liiiiO 


of  aorta  with  a  synthetic  graft  made  of 
teflon  or  dacron.  Since  most  abdominal  an- 
eurysms arise  distal  to  the  renal  arteries, 
the  aorta  can  be  cross-clamped  below  these 
vessels.  Before  the  aorta  is  cross-clamped, 
the  distal  site  of  anastomosis  is  determined 
and  these  vessels  are  made  ready  for  im- 
mediate anastomosis.  In  most  cases  the  in- 
ferior mesenteric  and  lumbar  arteries  can  be 
ligated  and  cut  prior  to  the  actual  cross- 
clamping  of  either  the  iliac  vessels  or  the 
abdominal  aorta  itself.  During  resection 
heparin  is  pumped  into  both  lower  extremi- 
ties through  a  small  polyethylene  tube  in- 
serted into  the  distal  arterial  system  by  the 
use  of  special  pumping  apparatus  or  with 
syringe  and  three-way  stop-cock.  The  an- 
eurysm is  then  removed  and  the  plastic  graft 
sutured  in  place  as  rapidly  as  possible. 

The  resection  of  a  ruptured  aneurysm  dif- 
fers in  that  the  patient  is  often  moribund 
or  in  semi-shock.  With  adequate  blood  for 
replacement,  temporary  proximal  control  of 
the  aorta  is  obtained  by  exerting  pressure  on 
the  upper  abdominal  aorta  against  the  spine 
in  the  lesser  peritoneal  sac  and  then  placing 
an  occluding  clamp  on  the  aorta  below  the 
renal  arteries.  The  iliac  vessels  are  cross- 
clamped  and  the  ruptured  aneurysm  is  rap- 
idly removed.  The  smaller  bleeding  vessels 
are  controlled  and  the  graft  is  sewn  in  place. 
In  all  cases  bilateral  lumbar  sympathectomy 
is  performed  prior  to  abdominal  closure. 

The  mortality  associated  with  resection 
of  aortic  aneurysms  is  about  5  to  10  per 
cent  in  the  uncomplicated  cases.  In  rup- 
tured aneurysms  it  is  still  25  to  50  per  cent, 
depending  on  the  patient's  general  condi- 
tion at  the  time  of  surgery. 

Dissecting  Thoracic  Aortic  Aneurysms 

The  predominant  presenting  symptom  of 
a  dissecting  thoracic  aortic  aneurysm  may 
be  acute  epigastric  abdominal  pain.  Usual- 
ly the  pain  is  substernal  in  origin  and  may 
simulate  myocardial  infarction ;  however, 
neurologic,  renal  and  abdominal  manifesta- 
tions are  frequent.  These  symptoms  consist 
of  numbness,  paraplegia,  coma,  hematuria, 
and  abdominal  pain  radiating  to  the  legs  or 
back'  and  are  usually  related  to  the  point  of 
dissection,  with  involvement  of  the  corre- 
sponding organ  systems.  The  presence  of 
neurologic  symptoms  or  signs  in  patients 
with  thoracic  or  abdominal  pain  may  be  a 
clue  to  the  early  correct  diagnosis  of  a  dis- 
secting thoracic  aortic  aneurysm. 


The  physical  manifestations  of  a  dissect- 
ing aneurysm  are  not  diagnostic.  A  precor- 
dial apical  or  basal  systolic  murmur  is  pres- 
ent in  about  40  per  cent  of  the  cases.  A  di- 
astolic murmur  over  the  aortic  area  is  con- 
sidered to  be  of  the  greatest  diagnostic  sig- 
nificance, but  is  present  in  only  a  small  per- 
centage of  cases.  This  is  simply  a  reflection 
of  the  small  number  of  individuals  with  in- 
volvement of  the  ascending  aorta  or  aortic 
annulus.  Brachial  blood  pressure  differen- 
tial, tracheal  deviation,  cervical  venous  dis- 
tention, abdominal  aneurysm,  or  obliteration 
of  peripheral  pulses  is  rarely  observed.  Elec-  i 
trocardiograms  reveal  myocardial  ischemia, 
left  ventricular  strain,  or  disturbances  of 
rhythm  in  about  75  per  cent  of  the  patients.    . 

Roentgenograms  of  the  chest  usually  re- 
veal widening  of  the  supracardiac  mediasti- 
num and  radiolucence  of  the  arch  and  de- 
scending aorta  in  the  region  of  the  false 
passage.  Angiocardiograms  taken  with  the 
patient  in  an  oblique  position  usually  ac- 
centuate the  "double-barreled"  appearance 
of  the  lesion.  This  examination  has  been  of 
utmost  value  in  determining  the  nature  and 
extent  of  the  dissecting  progess. 

For  the  cardiovascular  surgeon,  it  is  im- 
portant to  divide  these  lesions  into  five  cate- 
gories, which  then  provide  a  guide  to  the 
surgical   approach   and   prognosis'3'. 

Type  I :  The  dissecting  process  extends  from 
the  aortic  annulus  to  a  point  well  below 
the  diaphragm. 

Treatment:    Unless    there    is    an    area 

where    rupture    is    imminent,    resection 

with  graft  replacement  is  not  indicated. 

Creation  of  a  re-entry  passage  is  usually 

the  procedure  of  choice  and  may  be  done 

with  or  without  the  aid  of  hypothermia 

or  atriofemoral  by-pass  perfusion. 

Type    II :    The    process    is    localized    to   the 

ascending  aorta  and  proximal  transverse 

arch. 

Treatment:  Excision  of  the  lesion  and 
aortic    graft    replacement    using   extra- 
corporeal pump  oxygenator. 
Type   III :    Distal   transverse  arch   and   de- 
scending aorta. 
Type  IV:   The  dissecting  process  arises  atj 
the  left  subclavian  artery  and  continues 
well  below  the  diaphragm. 

Treatment:  Excision  of  diseased  tho- 
racic segment  and  intraluminal  closure 
of  distal  segment  prior  to  replacement 
grafting. 


August,  1960 


SYMPOSIUM  ON  ACUTE  CONDITIONS  OF  THE   ABDOMEN 


315 


Type  V :  Lesion  occurs  in  left  subclavian  ar- 
tery with  dissecting  process  remaining 
localized   in  the  descending   aorta. 

Treatment:  Excision  of  the  entire  dis- 
eased segment  and  replacement  with  a 
graft. 
The  latter  two  types  comprise  about  90 
per  cent  of  the  cases,  and  in  each  instance 
hypothermia  or  some  form  of  by-pass-shunt 
is  necessary  to  guard   against   spinal   cord 
ischemia. 

In  DeBakey's  series  of  60  cases  the  oper- 
ative mortality  of  lesions  occurring  below 
the  subclavian  was  18  per  cent  as  compared 
to  an  over-all  mortality  of  29  per  cent131. 
The  most  common  type  of  lesion  requires  re- 
section of  the  descending  aorta,  so  as  to  in- 
clude the  site  of  origin  of  the  dissection, 
with  graft  replacement  and  obliteration  of 
the  false  lumen  distally. 

Aneurysms  of  Intestinal  Vessels 
Aneurysms  of  the  major  aortic  branches 
to  the  abdominal  viscera  are  usually  palpable 
on  physical  examination,  produce  symptoms 
of  abdominal  pain,  and  have  the  great  ten- 
dency to  rupture  common  to  all  aneurysms. 
Splenic  aneurysms  occur  in  the  main  trunk 
of  the  vessel  and  are  twice  as  common  in 
women,  particularly  pregnant  women.  Sple- 
nomegaly is  found  in  about  50  per  cent  of 
the  patients,  and  before  rupture,  symptoms 
are  mild,  usually  consisting  only  of  epigas- 
tric discomfort.  Rupture  into  the  lesser 
peritoneal  sac  is  followed  by  severe  pain  in 
the  back  and  left  shoulder,  associated  with 
shock  or  signs  of  peritoneal  irritation.  The 
treatment  of  choice  is  resection  of  the  artery 
with  the  aneurysm,  and  splenectomy. 

In  aneurysms  involving  essential  vessels 
such  as  the  hepatic  and  superior  mesenteric 
artery,  resection  with  end-to-end  anastomo- 
sis of  the  vessel  is  performed  when  possible. 
Small  plastic  grafts  to  the  aorta  can  be  used 
effectively  when  primary  anastomosis  can- 
not be  performed. 

Embolism  and  Thrombosis  of  the  Superior 
Mesenteric  Artery 

The  superior  mesenteric  artery  is  the  ves- 
sel most  often  involved  in  infarction  of  the 
abdominal  viscera  in  both  sudden  embolic 
occlusions  and  arteriosclerotic  thrombosis. 
This  is  probably  related  to  the  relative  size 
of  the  vessel,  its  anterior  location,  and  the 
angle  it  makes  with  the  aorta  at  its  exit. 

Superior  mesenteric  arterial  embolism  is 
usually  associated  with  atrial  fibrillation,  a 
recent  myocardial  infarction,  or  some  other 


disease  which  provides  a  source  of  emboli. 
Sudden  severe  cramping  periumbilical  or 
epigastric  pain,  frequently  accompanied  by 
severe  pain  in  the  upper  lumbar  and  lower 
thoracic  region,  follows  complete  embolic  oc- 
clusion. The  patient  appears  to  be  in  early 
shock  and  acutely  ill,  but  the  blood  pressure 
may  be  normal  or  elevated.  The  bowel  re- 
sponds to  acute  ischemia  with  spastic  con- 
tractions and  loose  mucoid  stools.  Within 
two  hours  the  acute  pain  may  subside,  leav- 
ing the  patient  relatively  asymptomatic. 
Unless  the  condition  is  recognized,  the  error 
may  lead  to  a  fatal  postponement  of  opera- 
tive treatment.  The  white  blood  cell  count 
rises  early,  and  the  peritoneal  irritation  and 
abdominal  tenderness  make  their  appearance 
as  necrosis  of  the  intestine,  and  secondary 
bacterial  invasion  progresses.  Signs  of  gen- 
eralized peritonitis  with  abdominal  disten- 
tion, shock,  and  leukocytosis  develop,  to  com- 
plete the  classic  picture  of  massive  intes- 
tinal infarction.  Paracentesis  may  yield  a 
characteristic  dark,  "prune-juice"  tvpe  of 
fluid. 

Early  recognition  of  the  entity  and  prompt 
surgical  removal  of  the  embolus  before  ir- 
reversible injury  to  the  bowel  has  taken 
place  is  the  treatment  of  choice.  Reports  of 
successful  superior  mesenteric  embolectomy 
have  appeared  with  increasing  frequency 
since  the  urgency  and  value  of  the  operation 
was  stressed  by  Klass,!1. 

A  typical  history  in  a  patient  liable  to 
emboli,  who  begins  to  have  acute  abdominal 
pain  and  tenderness,  leukocytosis,  and  guiac- 
positive  stool-  with  absence  of  small-bowel 
gas  on  x-ray,  should  immediately  define  the 
need  for  emergency  surgery.  The  reversibil- 
ity of  apparently  severe  degrees  of  ischemic 
injury  to  the  intestine  after  sudden  occlusion 
of  the  circulation  has  been  striking.  Dark 
discoloration  of  the  bowel  does  not  neces- 
sarily mean  necrosis.  Even  if  necrosis  of 
segments  of  the  small  bowel  has  advanced 
to  a  point  of  no  return,  the  combination  of 
embolectomy  and  bowel  resection  may  allow 
the  preservation  of  a  greater  length  of  small 
intestine. 

Technique 
When  the  abdomen  is  explored  early,  there 
may  appear  to  be  very  minor  changes  in  the 
circulation  to  the  small  bowel.  A  good  pulse 
in  the  main  superior  mesenteric  artery  must 
be  demonstrated.  The  ligament  of  Treitz  is 
identified  and  the  mesocolon  and  lower  bor- 
der of  the   pancreas  are   reflected   upward, 


316 


NORTH  CAROLINA   MEDICAL  JOURNAL 


August,  1960 


exposing  the  superior  mesenteric  artery.  A 
heavy  ligature  is  passed  around  the  main 
trunk  of  the  artery  to  elevate  it,  and  the  first 
jejunal  and  middle  colic  branches  are  ex- 
posed. A  longitudinal  arteriotomy  incision 
is  made  and  the  clot  is  removed  proximally 
as  far  as  its  aortic  origin.  A  bulldog  arterial 
clamp  is  applied  after  the  vessel  has  been 
cleared  by  a  flush  of  aortic  blood.  The  distal 
thrombus  is  then  removed  by  milking  the 
mesenteric  vessels  toward  the  arteriotomy 
incision.  Heparin  is  injected  into  the  vessel 
proximately  and  distally,  and  the  incision 
is  closed  with  No.  6-0  black  silk.  Anticoag- 
ulants are  used  in  the  postoperative  period, 
along  with  antibiotics  and  the  usual  surgical 
measures  that  are  employed  after  an  explor- 
atory laparotomy. 

Arteriosclerotic  Thrombosis  of  the  Superior 
Mesenteric  Artery  tuid  Vein 

Small-bowel  infarction  resulting  from  ar- 
teriosclerotic thrombosis  of  the  superior 
mesenteric  artery  usually  occurs  by  gradual 
occlusion  of  this  vessel,  and  will  be  preceded 
by  days  or  months  of  chronic  gastrointes- 
tinal symptoms.  The  most  prominent  symp- 
tom is  a  cramping  epigastric  pain  appearing 
an  hour  or  two  after  meals;  weight  loss  is 
due  to  failure  to  eat  because  of  this  pain. 
Malabsorption  may  result  in  the  fatty  frothy 
stools  which  characterize  this  disorder.  In- 
farction will  be  accompanied  by  a  severe  at- 
tack of  abdominal  pain,  but  is  apt  to  be  less 
dramatic  in  onset  than  are  the  symptoms 
present  with  sudden  embolic  occlusion. 

Treatment  would  ideally  consist  of  recog- 
nition in  the  prodromal  phase,  aortographic 
demonstration  of  narrowing  of  the  vessel, 
and  correction  by  thromboendarterectomy 
or  replacement  grafting.  The  atheromatous 
occlusion  is  almost  always  located  in  the 
first  centimeter  and  the  adjacent  aortic 
wall'51.  The  vessel  is  cleared  in  a  retrograde 
fashion  with  a  small  curved  clamp  intro- 
duced into  the  aortic  lumen  through  the  su- 
perior mesenteric  arteriotomy.  Hemorrhage 
from  the  vessel  is  readily  controlled  by  digi- 
tal pressure  between  extraction  efforts.  The 
arteriotomy  is  closed,  with  attention  given 
to  distal  atheromas,  tacking  down  or  in- 
cluding in  the  suture  line  the  distal  intima 
to  avoid  subsequent  dissection. 

Thrombosis  of  the  mesenteric  vein  is  a 
rare  condition  usually  associated  with  intra- 
abdominal infection.  The  diagnosis  is  diffi- 
cult to  make  but  is  suggested  by  an  episode 
of  subacute  abdominal  pain  associated  with 


the  passage  of  blood  and  mucus  per  rectum. 
Specific  surgical  treatment  depends  on  the 
underlying  cause  and  the  location  of  the 
vascular  block. 

Aortic  Saddle  Embolus 

The  classic  evidence  of  a  saddle  embolus 
of  the  aorta  is  sudden  vascular  insufficiency 
of  the  lower  extremities  denoted  by  pain, 
pallor,  sensory  and  motor  losses,  and  absent 
pulses.  There  may  also  be  pain  in  the  abdo- 
men, lower  back,  buttocks  or  perineal  region, 
or  paresthesia  depending  upon  the  adequacy 
of  the  collateral  circulation.  The  embolus 
usually  arises  from  a  thrombus  in  a  rheu- 
matic heart  with  mitral  stenosis  or  insuffi- 
ciency and  atrial  fibrillation,  or  from  a  mural 
thromus  secondary  to  myocardial  infarction. 

The  prognosis  for  both  life  and  limb  is 
poor  without  embolectomy.  Reich"11  reported 
that  only  1  of  7  patients  not  operated  on 
survived.  Burt  and  others'7'  had  a  similar 
experience  with  16  patients,  8  of  whom  were 
treated  conservatively ;  only  two  lived  with- 
out loss  of  legs.  Four  of  8  were  operated  on 
successfully  without  loss  of  limbs.  In  general 
the  longer  the  delay  prior  to  operative  re- 
moval of  the  embolus,  the  poorer  the  prog- 
nosis, although  emboli  have  been  removed 
after  a  delay  of  24  hours'"'. 

The  operative  approach  may  be  transab- 
dominal, retroperitoneal  from  the  left  side, 
or  by  retrograde  catheter  suction  of  the 
femoral  artery.  The  transabdominal  ap- 
proach, employing  a  mid-line  or  paramedian 
incision,  is  the  most  popular.  After  proximal 
control  of  the  aorta  above  the  bifurcation 
and  the  iliac  vessels  below  the  embolus,  a 
longitudinal  incision  is  made  in  the  aorta 
overlying  the  clot.  The  embolus  is  removed 
and  blood  is  allowed  to  flush  from  both  iliacs 
to  clear  these  vessels  and  check  their  retro- 
grade flow,  and  then  to  clear  the  distal  aorta. 
The  aortic  incision  is  then  closed  with  con- 
tinuous No.  5-0  silk  sutures.  In  draping  the 
patient  prior  to  operation,  it  is  important 
to  have  both  legs  and  feet  in  the  operative 
field  so  that  peripheral  pulses  can  be  de- 
termined immediately  following  removal  of 
the  embolus  by  the  operating  surgeon.  The 
femoral  or  popliteal  arteries  can  be  explored, 
if  necessary,  to  clear  them  of  small  emboli 
that  may  have  broken  off  from  the  saddle 
embolus. 

The  retroperitoneal  approach  from  the 
left  sic1^  can  be  used  in  the  presence  of  peri- 
tonitis   or    extensive    intraperitoneal    adhe- 


August,  1960 


SYMPOSIUM  ON  ACUTE  CONDITIONS  OF  THE  ABDOMEN 


3n 


sions,  but  it  has  the  disadvantage  of  poor 
exposure  of  the  right  iliac  artery  and  of  the 
operative  site  in  general. 

The  retrograde  femoral  artery  approach'1' 
possesses  the  disadvantage  of  a  blind,  in- 
direct method,  yet  may  be  performed  suc- 
cessfully with  local  anesthesia,  thereby 
avoiding  a  laparotomy  in  a  seriously  ill  pa- 
tient. In  a  recent  study  Willman  and  Han- 
Ion110'  recommend  this  technique  not  only  for 
those  patients  who  are  critically  ill,  but  in 
all  patients.  If  the  clot  is  not  extracted  suc- 
cessfully, the  patient  can  be  put  to  sleep 
and  a  transabdominal  approach  used.  These 
authors  point  out  that  unsuccessful  attempts 
at  retrograde  femoral  removal  by  other  op- 
erators have  been  due  in  many  instances  to 
the  use  of  small  catheters. 

The  largest  thin-walled  plastic  catheter 
that  the  vessel  will  accept  is  passed  until  the 
catheter  impinges  on  the  embolus.  A  glass 
T  tube  allows  blood  from  collateral  vessels 
to  flow  through  the  vent  until  the  catheter 
tip  reaches  the  embolus-  then  the  suction  line 
is  opened  and  the  vent  is  closed.  Aspirated 
blood  and  thrombus  are  seen  through  the 
glass  T  tube.  The  catheter  is  slowly  with- 
drawn, together  with  the  firm  embolus  held 
against  the  tip  of  the  catheter  by  suction. 
The  same  technique  is  used  on  the  other 
side  and  is  repeated  until  there  is  a  vig- 
orous pulsital  blood  flow.  This  method  was 
used  successfully  on  4  patients,  but  cannot 
be  used  on  patients  with  previous  obstruc- 
tions or  thrombosis  in  the  iliac  vessels. 

In  the  postoperative  management  imme- 
diate heparinization  is  not  used  routinely 
after  the  abdominal  approach  if  adequate 
luminal  clearance  has  been  accomplished. 
The  complications  associated  with  immedi- 
ate heparinization  in  terms  of  wound  bleed- 
ing, hematoma,  delayed  wound  healing,  and 
secondary  infection  appear  to  outweigh  its 
possible  advantages.  After  the  retrograde 
femoral  artery  approach,  however,  immedi- 
ate heparinization  is  utilized. 

If  the  embolus  arises  from  the  left  atrium 
owing  to  mitral  stenosis,  mitral  commissu- 
rotomy and  atrial  appendectomy  is  prefer- 
able to  long-term  anticoagulant  therapy  if 
the  patient  can  tolerate  the  procedure.  One 
advantage  of  the  retrograde  femoral  ap- 
proach is  that  after  its  completion  under 
local  anesthesia  it  can  sometimes  be  com- 
bined immediately  with  mitral  commissu- 
rotomy. Belcher  and  Somerville'11'  found  a 
less  than  1  per  cent  incidence  of  postvalvu- 


lotomy  embolism  in  430  collected  cases,  and 
felt  that  commissurotomy  was  much  prefer- 
able to  long-term  anticoagulant  therapy. 

Summary 

Acute  abdominal  pain  of  vascular  origin  is 
most  commonly  due  to  the  development  of  an 
aneurysm,  thrombosis,  or  embolus  in  the 
arterial  system  within  the  abdomen.  In  gen- 
eral the  earlier  the  diagnosis,  the  better  the 
result  of  surgical  treatment. 

The  diagnosis  of  dissecting  or  ruptured 
abdominal  aneurysms  is  not  difficult,  as  the 
pulsating  mass  can  usually  be  felt.  Resec- 
tion of  the  aneurysm  with  graft  replace- 
ment is  a  lifesaving  procedure  when  success- 
ful. 

Dissecting  thoracic  aortic  aneurysms  may 
masquerade  as  an  acute  abdominal  condition, 
diagnosis  can  usually  be  made  by  x-ray 
studies,  and  surgical  treatment  consists  of 
resection  with  graft  replacement  or  construc- 
tion of  a  re-entry  passage. 

Embolism  or  thrombosis  of  the  superior 
mesenteric  artery  may  be  treated  by  em- 
bolectomy  or  thromboendarterectomy  if  rec- 
ognized early,  thus  avoiding  infarction  of 
the  small  bowel. 

Diagnosis  of  aortic  saddle  embolus  in  its 
early  stages  and  the  use  of  modern  vascular 
surgical  techniques  have  improved  the  sal- 
vage rate  considerably  in  the  past  10  years. 

References 

1.  DeBakey.  M.  E.,  Cooley.  D.  A.,  and  Creech.  O..  Jr.: 
Aneurysm  of  Aorta  Treated  by  Resection:  Analysis  of 
313  cases.  J.  A.  M.  A.   163:1439-1443   (April  20)    1957. 

2.  Wright.  I.  S.,  Urdaneta,  E.,  and  Wright,  B. :  Re-Open- 
ing the  Case  of  the  Abdominal  Aortic  Aneurysm.  Cir- 
culation  13:   754-768    (May)    1956. 

3.  DeBakey,  M.  E„  and  Henley,  W.  S. :  Dissecting  Ane- 
urysm of  the  Aorta.  Internat.  Forum,  8:   116-118,   1960. 

4.  Klass,  A.  A.:  Embolectomy  in  Acute  Mesenteric  Occlu- 
sion, Ann.  Surg.   134:  913-917   (Nov.  I    1951. 

5.  Derrick,  J.  R..  and  Logan,  W.  D.:  Mesenteric  Arterial 
Insufficiency,    Surgery   44:    823-827    (Nov.)    1958. 

6.  Reich,  N.  E.:  Occlusions  of  the  Abdominal  Aorta:  A 
Study  of  16  cases  of  Saddle  Embolus  and  Thrombosis. 
Ann.  Int.  Med.  19:  36-59  (July)   1943. 

7.  Burt,  C.  C.  Learmonth,  J.,  and  Richards,  R.  L.:  On 
Occlusion  of  the  Abdominal  Aorta.  Edinburgh  M.  J. 
59:   65-93    (Feb.)    1952. 

8.  Ewing.  M.  R. :  Aortic  Embolectomy.  Brit.  J.  Surg.  38: 
44-51    (July)    1950. 

9.  Randin,  I.  S..  and  Wood.  F.  C. :  The  Successful  Re- 
moval of  a  Saddle  Embolus  of  the  Aorta.  Eleven  Days 
After  Acute  Coronary  Occlusion,  Ann.  Surg.  114:834-839 
I  Nov.)    1941. 

10.  Willman.  V.  L..  and  Hanlon,  R. :  Safer  Operation  in 
Aortic  Saddle  Embolism,  Four  Consecutive  Successful 
Embolectomies  via  the  Femoral  Arteries  Under  Local 
Anesthesia,  Ann.  Surg.  150:568-574   (Oct.)   1959. 

11.  Belcher,  J.  R..  and  Somerville,  W.:  Systemic  Embolism 
and  Left  Auricular  Thrombosis  in  Relation  to  Mitral 
Valvolotomy.  Brit.   M.  J.  2:   1000-1003   (Oct.   22)    1955. 


318 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August.  19(30 


Diagnosis  and  Treatment  of 
Intussusception  in  Infants  and  Children 


Louis  Shaffner,  M.D.* 
Winston-Salem 


Intussusception  is  the  invagination  or 
telescoping  of  a  portion  of  bowel  into  the 
bowel  distal  to  it.  It  occurs  usually  in  the 
region  of  the  terminal  ileum,  being  of  the 
ileo-colic  type;  but  colo-colic,  ileo-ileal,  and 
the  treacherous  and  complicated  ileo-ileo- 
colic  types  are  occasionally  encountered. 

The  mesenteric  blood  vessels  are  pulled  in 
between  the  layers  of  bowel  and  subsequently 
obstructed  by  tension  and  pressure.  The  re- 
sult is  a  strangulating  process  of  the  intus- 
suscepted  portion  and  a  mechanical  obstruc- 
tion of  the  innermost  lumen  from  the  result- 
ant edema  of  the  bowel  wall. 

If  left  untreated,  95  per  cent  of  the  pa- 
tients will  die.  The  few  who  recover  do  so 
by  a  spontaneous  reduction  or  a  sloughing 
of  the  gangrenous  portion  into  the  distal 
bowel,  with  relief  of  the  obstruction. 

Intussusception  is  an  acute  painful  ab- 
dominal condition  and  a  discussion  of  it  fits 
in  well  with  the  other  papers  presented  on 
this  program.  It  is,  however,  unique  among 
the  subjects  covered  in  that  it  occurs  prin- 
cipally in  infants  and  children.  As  such, 
the  discussion  of  it  can  serve  as  a  reminder 
of  the  value  of  modifying  for  infants  and 
children  the  procedure  of  physical  examina- 
tion usually  followed  in  adults. 

Intussusception  furthermore  is  a  condi- 
tion about  which  there  is  no  complete  agree- 
ment as  to  the  best  form  of  treatment. 
Ravitch"1  has  emphasized  again  the  value  of 
a  barium  enema  under  hydrostatic  pressure 
as  the  initial  therapy  prior  to  any  operative 
approach. 

Our  experiences  with  22  cases  at  the 
North  Carolina  Baptist  Hospital  will  be 
summarized. 

Diagnosis 

Some  80  to  90  per  cent  of  reported  cases 
of  intussusception  occurred  in  children  un- 
der 2  years  of  age,  the  majority  ranging 
between  3  and  11  months.  The  patients  are, 
therefore,  old  enough  to  complain  but  too 
young  to  describe  their  complaints. 

The  mother  usually  states  that  the  baby 
had  been  entirelv  well  until  suddenly  he  be- 


*From    the    Department    of    Surgery.    Bowman    Gray    School 
of  Medicine.  Winston-Salem.  N.   C. 


gan  to  have  severe  attacks  of  "colic,"  char- 
acterized by  an  agonizing  cry  of  pain,  pallor, 
a  drawing  up  of  the  legs  upon  the  abdomen, 
and  vomiting.  This  might  last  30  seconds  to 
a  minute,  followed  by  apparent  relief  for 
minutes  to  hours,  only  to  be  repeated  again 
and  again  until  the  baby  looked  limp,  refused 
all  feedings,  and  perhaps  became  distended. 
A  normal  bowel  movement  might  occur,  and 
after  several  hours  there  may  be  some  blood, 
bright  red  or  the  dark,  so-called  "currant 
jelly"  type,  mixed  with  the  stools. 

It  should  be  emphasized  that  blood  in  the 
stools  is  not  an  early  manifestation,  for  when 
it  does  occur  it  is  an  indication  of  consider- 
able venous  obstruction  in  the  involved  bow- 
el, causing  ulceration  and  bleeding  of  the 
mucosa.  The  symptoms  are  suggestive 
enough  of  intussusception  before  blood  ap- 
pears, yet  experience  has  shown  that  the 
appearance  of  blood  does  not  mean  that  the 
bowel  is  gangrenous  and  that  resection  will 
be  mandatory. 

The  important  positive  sign  during  exam- 
ination of  the  abdomen  is  the  presence  of  an 
elongated  or  sausage-shaped,  only  slightly 
tender,  mass  anywhere  along  the  course  of 
the  colon.  This  may  vary  in  size  with  peris- 
taltic activity,  or  be  constant  in  size  and 
definitely  tender,  indicating  more  edema  and 
a  more  severe  impairment  of  the  blood  sup- 
ply. A  relative  emptiness  of  the  right  lower 
quadrant,  known  as  Dance's  sign,  is  difficult 
to  interpret,  but  if  present  suggests  that  an 
elusive  mass  may  be  hiding  either  under  the 
liver  edge  or  under  the  left  rib  cage  at  the 
splenic  flexure. 

Peristalsis  will  be  that  of  small  bowel  colic, 
and  when  it  is  heard,  the  child  will  at  the 
same  time  tighten  his  abdominal  muscles 
and  cry  until  the  episode  is  passed. 

Method  of  Examination 
Examination  of  the  "acute  abdomen"  in 
an  inarticulate,  uncooperative,  frightened, 
crying,  irritable,  sick  baby  can  be  a  difficult 
and  unrevealing  procedure  unless  the  rou- 
tine is  modified  from  that  used  in  adults. 

A  general  inspection  of  the  baby  will  re- 
veal by  his  color,  attitude,  and  activity 
whether  he   is  acutely   ill   and   whether  his 


August,  1960 


SYMPOSIUM  ON  ACUTE  CONDITIONS  OF  THE  ABDOMEN 


319 


abdomen  is  distended  or  a  hernia  protrudes. 
If  the  baby  is  lying  quietly  in  his  mother's 
arms  when  first  seen,  then  is  the  opportune 
time  to  place  the  stethoscope  gently  on  the 
abdomen  to  determine  peristalsis  and,  if  he 
remains  quiet,  to  listen  to  the  anterior  chest. 

Gentle  and  light  palpation  with  a  warm 
hand  comes  next.  If  there  is  no  distention, 
it  is  usually  easy  to  determine  the  presence 
of  muscle  spasm  or  a  palpable  mass.  It  is 
gratifying  to  find  that  if  this  initial  palpation 
is  gentle,  light,  and  slow,  any  response  from 
the  baby  such  as  a  whimper,  a  squirm,  a 
facial  wince,  or  a  sudden  tightening  of  the 
musculature  is  a  reliable  sign  of  tenderness 
beneath  the  palpating  hand.  These  actions 
can  speak  as  loudly  as  words  to  say,  "That 
hurts."  If  at  the  first  such  sign  the  examiner 
removes  his  hand,  the  baby  will  usually  be- 
come quiet  again.  More  thorough  palpation 
of  the  non-tender  areas  can  then  be  repeated, 
and  finally  the  tender  area  confirmed. 

Percussion  of  the  abdomen  can  be  as  much 
a  test  for  rebound  tenderness  as  for  tympany 
or  shifting  dullness.  If  done  very  gently,  it 
too  can  localize  the  tender  area  by  the  same 
responses. 

But  what  if  the  baby  is  crying  and  tossing 
when  first  seen,  and,  as  often  happens,  has 
been  taken  from  his  mother,  disrobed,  held 
naked  on  a  cold  table,  and  a  thermometer 
thrust  up  his  rectum?  Or  what  if  one  gags 
his  throat,  pokes  his  ears,  twists  his  neck, 
turns  him  over,  and  thumps  his  chest  be- 
fore examining  his  abdomen? 

There  is  only  one  answer.  The  baby  must 
be  quieted  down  and  relaxed  before  the  ab- 
dominal examination  can  be  satisfactory. 
Maybe  a  few  minutes  in  his  mother's  arms 
will  do  it.  If  he  isn't  vomiting,  maybe  a 
bottle  or  a  sugar  nipple  will  do  it.  But  it 
may  also  take  a  pentobarbital  suppository 
or  a  subcutaneous  injection  of  Demerol 
(1.0  mg.  per  pound)  20  or  30  minutes  to 
do  it.  If  such  sedation  seems  necessary,  it 
should  be  used  for  the  good  of  everybody 
concerned. 

Certainly  a  complete  examination  should 
be  done,  but  in  an  order  and  a  manner  that 
allows  a  thorough  abdominal  examination  in 
a  quiet,  relaxed  child.  The  final  rectal  exam- 
ination is  done  not  only  to  check  for  blood 
but  also  for  tender  masses.  At  times  the 
leading  point  of  an  intussusception,  like  a 
small  cervix,  can  be  felt  within  the  rectal 
ampulla. 


Differential  Diagnosis 

There  are  no  other  conditions  that  present 
the  findings  of  a  typical  intussusception. 
But  sometimes  the  signs  of  small  bowel  ob- 
struction are  dominant,  and  the  distention 
prevents  palpation  of  the  intussuscepted 
mass.  An  ulcerated  Meckel's  diverticulum 
alone  or  a  polyp  can  cause  bloody  stools,  and 
appendicitis  and  all  forms  of  acute  enteritis 
must  be  thought  of. 

When  the  diagnosis  of  intussusception  is 
suspected  but  no  abdominal  mass  is  palpable, 
a  barium  enema  for  diagnosis  alone  will 
settle  the  issue  and  at  times  will  cure  the 
disease.  The  retrograde  flow  of  barium  will 
slow  at  the  leading  point  of  the  intussuscep- 
tion, then  outline  it  with  the  "coiled  spring" 
sign,  and  sometimes  reduce  it  in  seconds. 

Treatment 

Basically  the  treatment  of  intussusception 
is  that  of  relieving  an  intestinal  obstruction 
at  the  point  of  the  obstruction.  Supportive 
measures  to  correct  dehydration  and  relieve 
intestinal  distention  should,  of  course,  be 
started  as  soon  as  the  diagnosis  is  made. 

The  only  controversy  seems  to  be  whether 
an  initial  trial  at  reduction  by  a  barium  en- 
ema under  hydrostatic  pressure  is  safe  and 
effective.  Even  the  opponents  of  such  a  trial'2' 
admit  they  have  seen  barium  enemas  given 
primarily  for  diagnosis  cause  ready  reduc- 
tions and  obviate  an  operation.  These  have 
occurred  principally  in  patients  seen  within 
24  hours  of  the  onset  of  symptoms. 

Ravitch(1341  in  urging  the  routine  trial 
of  this  method,  presents  convincing  evidence 
from  Scandinavian  and  Australian  clinics 
and  from  his  own  experience  that  it  is  ef- 
fective in  3  out  of  4  cases  and  is  attended 
by  much  less  morbidity  and  mortality  than 
operative  treatment  alone.  He  reports  no 
deaths  in  65  patients  so  treated,  and  in  cases 
of  successful  reduction  by  the  enema  the 
hospital  stay  was  only  one-third  as  long  as 
those  requiring  operation. 

He  refutes  the  objections  of  others  by 
pointing  out  that  with  his  method  irreduc- 
ible bowel  will  not  rupture  nor  a  gangrenous 
one  be  reduced.  There  is  less  trauma  to  the 
bowel  itself  than  by  manual  reduction.  There 
will  be  a  correctable  cause,  such  as  a  polyp 
or  Meckel's  diverticulum,  in  only  5  per  cent 
of  the  patients,  and  none  of  these  require 
immediate  removal.  If  complete  reduction 
is  not  successfully  demonstrated,  there  is  no 
delay ;  surgical  exploration  is  performed  im- 
mediately through  a  McBurney  incision. 


320 


NORTH   CAROLINA  MEDICAL  JOURNAL 


August,  1900 


Table  1 

Symptoms  and  Signs 

22  Cases 

No.    PerCent 

Intermittent  abdominal  pain 22  100 

Vomiting 22  100 

Bloody  stools  16  73 

Palpable  abdominal  mass 14  64 

Abdominal  distention-obstruetion  4  18 

He  finally  stresses  the  point  that  this  is  a 
hospital  surgical  procedure  and  can  be  sim- 
ply compared  to  an  initial  attempt  at  a  closed 
reduction  of  a  fracture.  If  not  successful, 
open  reduction  may  be  necessary.  Physicians 
will  refer  suspected  cases  sooner,  and  par- 
ents will  readily  agree  to  early  hospitaliza- 
tion if  by  so  doing  there  is  an  excellent 
chance  of  cure  without  an  operation. 

Technique 

Ravitch's  method  in  the  use  of  barium 
under  fluoroscopic  control  may  be  summar- 
ized as  follows:  (1)  Insert  a  45  cc.  Foley 
bag  catheter  in  rectum;  (2)  maintain  a  3- 
foot  elevation  of  barium  reservoir;  (3)  per- 
sist with  constant  pressure  if  progress  made ; 
(4)  proceed  with  surgical  exploration  if 
ileum  is  not  well  filled;  and  (5)  instill  pow- 
dered charcoal  into  the  stomach  if  reduction 
is  apparent. 

His  criteria  of  reduction  are:  (1)  free 
flow  of  barium  into  small  bowel;  (2)  return 
of  feces  or  flatus  with  barium;  (3)  disap- 
pearance of  mass;  (4)  clinical  improvement, 
and   (5)   recovery  in  stool  of  charcoal. 

Summary  of  Cases 

Twenty-two  cases  of  intussusception  in  the 
pediatric  age  group  have  been  seen  at  the 
North  Carolina  Baptist  Hospital  from  1946 
through  1959.  This  represents  20  patients, 
2  having  been  admitted  twice  for  a  recur- 
rence of  the  condition.  There  were  14  males 
and  6  females.  Thirteen  were  between  the 
ages  of  3  months  and  2  years,  6  from  2  to  4 
years  of  age,  and  3  from  5  to  10  years  of 
age. 

The  predominant  signs  and  symptoms  are 
noted  in  table  1.  The  duration  of  symptoms 
from  onset  to  initiation  of  treatment  varied 
from  four  hours  to  four  days.  The  correct 
diagnosis  was  suspected  clinically  in  all  pa- 
tients except  the  4  showing  predominantly 
the  signs  of  small  bowel  obstruction. 

Our  only  death  was  in  one  of  these,  a  3 
year  old  girl  who  was  admitted  with  a  four 
hour  history  of  intermittent  abdominal  pain 
and  vomiting,  preceded  the  day  before  by 
passage  of  a  bloody  stool  without  pain.  The 
abdominal  examination  revealed  no  masses, 


Table   2 
Treatment 
(22  Cases) 
Nonoperative   reduction 

Spontaneous     

Plain  enema 


Barium    enema 


3 
8 

4* 

15 


Total 

Operative   treatment 

Exploratory    (obstruction   already   reduced) .... 

Manual   reduction  

Resection   or  exteriorization   

Total 

*  1  death:  operative  mortality  1% 

or  tenderness,  but  peristaltic  rushes  were 
heard  that  coincided  with  apparent  pain.  No 
blood  was  found  in  the  stools.  A  plain  roent- 
genogram of  the  abdomen  was  not  diagnos- 
tic. After  a  24-hour  delay  during  which 
symptoms  progressed,  a  diagnostic  barium 
enema  revealed  an  intussusception  in  the 
cecum.  At  operation  an  ileo-colic  mass  was 
reduced,  and  a  gangreous  portion  of  ileum 
containing  an  ectopic  pancreatic  nodule  was 
resected.  Hyperpyrexia  and  convulsions  de- 
veloped during  the  procedure  and  the  patient 
died  two  hours  later.  An  autopsy  was  not 
obtained. 

Only  15  of  the  cases  required  operation, 
table  2.  The  clinical  diagnosis  in  the  4  that 
were  reduced  spontaneously  or  by  plain  en- 
emas was  certain  enough  to  be  included  in 
the  group.  Diagnosis  of  the  other  3  was  con- 
firmed at  the  time  of  reduction  by  barium 
enema.  The  one  death  gives  an  operative 
mortality  of  7  per  cent  and  an  over-all  mor- 
tality of  4.5  per  cent. 

Table   3 

Etiology 

15  Operative  Cases 

Antecedent   diarrhea    

Hyperplastic    Peyer's    patch   

Meckel's   diverticulum   

Ectopic  pancreas  in  ileum 

Papilloma  of  cecum  

Mobile    cecum    

Prominent  ileo-cecal  valve  

Recent  bowel  surgery  

Idiopathic    


.._ 2 


Probable  etiologic  factors  in  the  15  oper- 
ative cases  are  listed  in  table  3.  The  hyper- 
plastic Peyer's  patches  seemed  to  be  the  lead- 
ing points  in  2  cases,  and  in  each  the  appear- 
ance of  the  mesenteric  nodes  was  compatible 
with  a  coincident  diagnosis  of  mesenteric 
adenitis. 

Barium  enema  examinations  were  done  in 
13  patients.  The  other  9  included  those  who 
improved  spontaneously  or  after  a  plain 
enema  and  those  who  were  considered  can- 
didates for  exploration  for  severe  obstruc- 


August.  1960 


SYMPOSIUM  ON  ACUTE  CONDITIONS  OF  THE  ABDOMEN 


321 


Table  4 
Barium   Enema   in   Intussusception 
Attempted   reduction   _ 11 

Successful — no  surgery  3 — 21'', 

Successful — proved  at  surgery  2 

Unsuccessful — operative  treatment  6 

tion.  In  only  11  was  any  attempt  made  to 
reduce  the  intussusception  by  hydrostatic 
pressure,  table  4.  This  was  successful  in 
only  3  patients  (27  per  cent),  symptoms 
having  been  present  12  hours  in  2  and  4 
days  in  the  third.  In  2  additional  cases  op- 
eration disclosed  complete  reduction,  even 
though  the  terminal  ileum  had  not  filled  with 
barium.  Symptoms  had  been  present  less 
than  12  hours  in  each  of  these  cases. 

Comment 

The  two  recurrent  cases  are  of  interest. 
In  one,  the  first  episode  occurred  at  13 
months  of  age,  and  after  an  unsuccessful 
attempt  at  reduction  by  barium  enema  an 
ileo-ileo-colic  type  of  intussusception  was  re- 
duced at  operation.  When  similar  symptoms 
recurred  at  the  age  of  3  years,  exploration 
was  done  without  a  preliminary  enema  and 
an  ileo-ileal  type  was  found  to  have  been  re- 
duced spontaneously. 

In  the  other  the  first  episode  occurred  at 
16  months  of  age,  barium  enema  was  unsuc- 
cessful, and  an  ileo-colic  type  of  intussuscep- 
tion was  easily  reduced  at  operation.  The 
intussusception  recurred  at  the  age  of  2i/o 
years,  was  easily  reduced  by  a  barium  en- 
ema, and  the  patient  was  discharged  48  hours 
later.  Three  months  later  she  had  a  third 
episode  of  intermittent  pain,  vomiting,  and 
passage  of  a  grossly  bloody  stool  during  a 
12-hour  period.  She  then  improved  spon- 
taneously, and  four  hours  later  examination 
of  the  abdomen  was  normal  and  barium  en- 
ema showed  no  intussusception.  A  barium 
study  of  the  small  bowel  was  subsequently 
normal.  When  seen  recently  at  age  14,  she 
had  had  no  further  trouble.  Undoubtedly, 
the  third  attack  was  due  to  another  intus- 
susception which  was  reduced  spontaneously. 

These  2  cases  illustrate  that  a  past  history 
of  an  intussusception  requiring  operative 
reduction  does  not  necessarily  imply  that  a 
recurrent  episode  will  demand  another  op- 
eration. A  barium  enema  might  prove  a 
spontaneous  reduction  or  effect  a  therapeu- 
tic one. 

This  series  of  22  cases  is  admittedly  a 
■  small  number  from  which  to  draw  conclu- 
sions. Nevertheless,  we  certainly  have  had 
;  no  complications  from  trying  reduction  by 


barium  enema,  and  the  successful  patients 
have  gone  home  in  less  than  three  days.  In 
retrospect  several  of  our  operative  cases, 
including  the  fatality,  might  have  been  di- 
agnosed and  treated  sooner  had  a  barium 
enema  been  done  at  the  first  suspicion  of 
intussusception. 

Our  radiologists  have  been  reluctant  to 
prolong  or  persist  at  any  attempt  at  reduc- 
tion as  long  as  Ravitch  does.  And  our  sur- 
geons have  withheld  exploration  only  when 
the  evidence  of  complete  reduction  was  quite 
convincing.  Yet  with  this  conservative  ap- 
proach we  have  had  some  success  and  have 
done  no  harm.  As  we  gain  experience  our 
percentage  of  reductions  with  barium  enema 
may  rise.  The  more  we  encourage  early  di- 
agnosis by  requesting  a  barium  enema  in  all 
suspected  cases,  the  better  chance  we  have 
to  treat  these  babies  safely,  simply,  and 
easily. 

Summary 

Intussusception  should  be  suspected  in 
any  infant  with  a  history  suggestive  of  the 
sudden  onset  of  small  bowel  obstruction. 

A  satisfactory  examination  of  the  "acute 
abdomen"  in  an  infant  requires  a  modifica- 
tion of  the  order  and  manner  of  examination 
usually  used  in  adults.  The  infant  must  be 
quiet  and  relaxed. 

Ravitch's  method  of  an  attempt  at  reduc- 
tion by  barium  enema  under  hydrostatic 
pressure  has  led  to  earlier  diagnosis,  suc- 
cessful treatment  in  3  out  of  4  cases,  and  a 
reduction  in  over-all  morbidity. 

Twenty-two  cases  have  been  analyzed. 
Three  of  11  intussusception  were  reduced 
by  barium  enema  without  operation.  Out  of 
15  operative  cases  there  was  one  death,  that 
attributable  to  a  delay  in  diagnosis  which 
could  have  been  reached  sooner  if  a  barium 
enema  had  been  done  when  first  indicated. 

A  barium  enema  in  all  suspected  cases  can 
lead  not  only  to  an  earlier  diagnosis,  but  also 
to  an  easier  and  simpler  cure. 

References 

1.  Ravitch,  M.  M. :  Non-Operative  Treatment  of  Intus- 
susception; Hydrostatic  Pressure  Reduction  by  Barium- 
Enema  Under  Fluoroscopic  Control;  Current  Surgical 
Management,  Philadelphia,  W.  B.  Saunders  Co.,  1957. 
pp.  358-367. 

2.  (a)  Fox,  P.  P.:  Intussusception:  Surgical  Treatment. 
S.  Clin.  North  America  36:  1501-1509  (Dec.)  1956.  (b) 
Gross,  R.  E. :  The  Surgery  of  Infancy  and  Childhood, 
Philadelphia,    W.    B.    Saunders    Co.,    1933,    pp.    281-300. 


322 


NORTH   CAROLINA  MEDICAL  JOURNAL 


August,  I960 


(c)  Izant.  R.  J.,  Jr..  and  Clatworthy.  H.  W..  Jr.:  Sur- 
gical Treatment  of  Intussusception:  Current  Surgical 
Management.  Philadelphia.  W.  B.  Saunders  Co..  1957. 
pp.  349-357.  (d)  Swenson.  Orvar:  Pediatric  Surgery.  New 
York.  Appleton-Century-Crofts,  Inc..  1958,  pp.  328-340. 
If)  Potts.  W.  J.:  The  Surgeon  and  the  Child.  Phila- 
delphia, W.  B.  Saunders  Co.,  1959,  pp.   167-170. 


:i.  Ravitch,  M.  M.,  and  McCune.  R.  M.,  Jr.:  Reduction  of 
Intussusception  by  Barium  Enema,  Clinicpl  and  Ex- 
perimental    Study,     Ann.     Sure.     128:904-917      'Nov.)     1948. 

4.  Ravitch.  M.  M.:  Reduction  of  Intussusception  by  Ba- 
rium   Enema,    Surg.    Gyn.    Obst.    99:431-436     (Oct.)    1954. 


The  Diagnosis  and  Treatment  of  Acute  Diverticular 

Disease  of  the  Colon 

E.  Jackson  Dunning,  M.D.,  F.A.C.S. 
Charlotte 


Diverticula  of  the  colon  are  of  two  types : 
congenital  and  acquired.  They  are  separate 
entities.  The  congenital  diverticulum  is  a 
true  diverticulum  and  therefore  contains  all 
the  layers  of  the  normal  colon  wall.  This 
type  is  rare,  is  usually  solitary,  appears  most 
frequently  in  the  cecum,  and  seldom  causes 
symptoms  unless  acutely  inflamed'1'.  The 
acquired  variety  (fig.  1),  being  by-products 
of  degeneration,  are  false  diverticula ;  they 
are  usually  multiple  and  usually  appear  after 
40  years  of  age,  when  the  incidence  in- 
creases'-1. These  diverticula  are  found  most 
often  in  the  sigmoid  colon  and  occur  with 
diminishing  frequency  from  the  left  side  of 
the  colon  to  the  right  side(:,).  Predisposing 
factors — for  example,  narrowing,  spasm, 
stasis,  and  increased  intraluminal  pressure 
— are  most  pronounced  in  the  sigmoid'4'. 
This  probably  also  accounts  for  the  fact  that 
the  inflammation  of  the  diverticula  usually 
occurs  only  in  the  sigmoid  and  rarely  in  any 
other  segment  of  the  colon'3"-  5'. 

It  has  been  said  that  diverticulosis  coli 
will  be  found  in  5  to  10  per  cent  of  people 
who  undergo  a  barium  enema,  and  that 
about  15  per  cent,  or  8  patients  in  1,000,  will 
probably  have  some  type  of  diverticulitis'3"'6'. 
Undoubtedly  the  incidence  of  diverticular 
disease  and  its  complications  will  steadily 
increase  with  our  lengthening  life  span27'. 
The  more  diverticula  present  in  the  colon, 
the  greater  the  chance  of  developing  some 
form  of  diverticulitis,  but  the  age  of  onset  of 
diverticulosis  does  not  influence  the  likeli- 
hood of  the  onset  of  inflammation'*1. 

Classification 

Diverticular  disease  of  the  colon,  and  of 
the  sigmoid  colon  in  particular,  can  give  rise 
to  a  number  of  acute  processes  which  should 
be  considered : 

1.    Acute  sigmoiditis'1". 


This  process  may  progress  to  frank 
peritonitis,  or  obstruction,  or  pericolic 
abscess  formation. 

2.  Perforation  of  a  diverticulum  with  or 
without  inflammation'1'". 

3.  Hemorrhage. 

Bleeding  may  be  acute  and  massive 
with  or  without  diverticulitis'111. 

4.  Acute  diverticulitis  with  small  bowel 
obstruction. 

5.  Acute    diverticulitis    with    fistula    or 
sinus  formation. 

6.  Acute  diverticulitis  with  cancer  or  con- 
fused with  cancer. 

Obviously,  the  complications  of  diverticu- 
losis coli  are  rarely  so  distinctly  set  apart 
clinically;  rather,  the  involvement  or  changes 
in  any  given  case  may  encompass  one  or  all 
of  these  pathological  processes.  Also  it 
should  be  stated  that  any  of  these  clinical 
pictures  may  appear  without  the  slightest 
suggestion  of  prior  colon  disease'11'". 

Diagnosis 

1.  Acute  sigmoiditis:  The  typical  picture 
of  acute  diverticulities  or  acute  sigmoiditis 
is  that  of  a  middle-aged,  obese,  constipated, 
sedentary  individual  with  pain  in  the  left 
lower  quadrant  of  the  abdomen'12'  or  left 
iliac  fossa (3b).  A  history  of  diverticulitis  is 
helpful,  for  45  per  cent  of  patients  who  have 
one  attack  of  diverticulitis  will  have  another 
attack'131.  The  pain  and  signs  may  be  right- 
sided  if  the  redundant  and  inflamed  colon 
lies  to  that  side.  Also,  diarrhea  may  be  a 
complaint  or  diarrhea  alternating  with  con- 
stipation. 

Examination  reveals  the  objective  evi- 
dence of  infection — for  example,  the  eleva- 
tion of  temperature,  pulse  rate,  and  white 
blood  count  plus  the  signs  of  intraperitoneal 
inflammation :  abdominal  distention,  dimin- 
ished peristaltic  activity,  abdominal  tender- 


August,  1960 


SYMPOSIUM  ON  ACUTE  CONDITIONS  OF  THE   ABDOMEN 


323 


Fig.  1.  Photomicrograph   (x  1)   of  an  acquired  di- 
verticulum of  colon. 

ness,  rebound  tenderness  in  the  lower  part 
of  the  abdomen,  muscle-guarding  over  the 
sigmoid,  and  possibly  a  palpable  sausage- 
shaped  mass.  The  patient's  age — that  is, 
whether  child  or  adult — and  the  origin  of 
the  pain  further  help  to  distinguish  this 
process  from  appendicitis.  In  appendicitis 
the  pain  characteristically  begins  above  the 
umbilicus  and  is  likely  to  be  associated  with 
nausea  and  vomiting,  while  the  pain  of  sig- 
moiditis originates  below  the  umbilicus  and 
is  less  likely  to  be  accompanied  by  nausea 
and  vomiting1'1".  In  diverticulitis  the  pain 
may  come  and  go  over  a  period  of  weeks. 
Salpingitis,  tubo-ovarian  abscess,  ovarian 
tumors,  strangulated  hernia,  sigmoid  volvu- 
lus, and  mesenteric  thrombosis  are  diag- 
noses which  should  be  considered.  A  small, 
carefully  administered  barium  enema  is  the 
best  single  diagnostic  test'12'. 

2.  Perforation:  Free  perforation  of  a  di- 
verticulum of  the  colon  is  much  more  com- 
mon than  generally  realized  and  usually 
happens  with  little  or  no  warning171".  The 
pain  produced  is  severe  and  knife-like,  and 
may  radiate  to  the  back,  hip,  thigh,  anus, 
or  genitalia'12'.  Typically  it  is  associated 
with  nausea,  vomiting,  and  distention,  with 
the  development  of  severe  intraperitoneal 
reaction  such  as  that  seen  in  the  rupture  of 
any  other  hollow  viscus.  An  upright  chest 
film  will  often  show  the  subphrenic  air  (fig. 
2)  and  narrow  the  diagnosis  to  rupture  of 
peptic  ulcer  or  diverticulum.  A  good  history 
of  any  prior  difficulty,  together  with  the 
point  of  major  abdominal  tenderness,  should 
■  aid  in  making  the  proper  diagnosis. 

3.  Hemorrhage:  Bleeding  in  diverticulosis 
coli  has  been  reported  in  from  4  to  28  per 


Fig.  2.  Upright  roentgenogram  of  the  chest  show- 
ing subphrenic  air  accumulation  from  perforation 
of  colon   diverticulum. 

cent  of  the  patients,  but  the  number  exhibit- 
ing massive  hemorrhage  is  much  smaller'11"1. 
Bleeding  from  other  benign  colon  and  ano- 
rectal lesions  must  be  ruled  out  by  barium 
enema  and  sigmoidoscopic  examination,  but 
it  is  especially  important  to  rule  out  malig- 
nancy as  a  source  of  hemorrhage.  Earley(Ub) 
has  compiled  from  his  experience  and  others 
the  following  criteria  for  concluding  that 
the  bleeding  arises  from  diverticular  dis- 
ease: 

1.  Passage  by  rectum  of  bright  or  dark 
blood ; 

2.  Sigmoidoscopy,  barium  enema,  and  air 
contrast  studies  showing  diverticular 
disease  and  excluding  other  potentially 
bleeding  lesions ; 

3.  Stomach  and  small  intestine  normal  to 
x-ray  visualization ; 

4.  Normal  coagulability  of  blood. 

4.  Acute  diverticulitis  with  small  bowel 
obstruction : 

This  complication  has  not  been  adequately 
stressed  in  discussions  of  diverticulitis' 71>- 9|. 
The  clinical  picture  produced  is  one  of  acute 
sigmoiditis  together  with  the  picture  of  small 
bowel  obstruction, — namely,  nausea,  vomit- 
ing, cramp-like  pains,  abdominal  distention, 
rushes  of  peristalsis,  and  fluid-air  levels  in 
dilated  small  bowel  on  erect  x-ray  films  of 
the  abdomen"".  This  problem  must  be  dis- 
tinguished from  the  myriad  of  causes  of 
small  bowel  obstruction,  especially  those 
with  associated  intraperitoneal  infection. 

5.  Acute  diverticulitis  with  fistula  or  sinus 
formation:  The  formation  of  a  vesico-colic 
fistula  (fig.  3)  may  be  heralded  by  symp- 
toms of  cystitis'2-  !1>,  and  even  after  the  rup- 


:m 


NORTH  CAROLINA   MEDICAL  JOURNAL 


August,  1960 


Fig.  3.  Barium  enema  roentgenogram  revealing 
extensive  diverticulosis  of  sigmoid  colon  and  air 
in  (he  bladder  as  a  result   of  a  vesicolonic  fistula. 

ture  into  the  bladder  has  taken  place  the 
patient's  symptoms  are  largely  directed  to 
the  genitourinary  tract14'.  Cripps'151  has 
stated  that  inflammatory  lesions  more  fre- 
quently cause  sigmoidovesical  fistulas  than 
do  malignant  lesions.  Fistulas  between  the 
colon  and  affixed  small  bowel  may  occur,  with 
resultant  abdominal  cramps  and  diarrhea, 
or  the  inflammatory  process  may  burrow  to 
the  skin  to  form  a  colocutaneous  sinus. 

6.  Acute  diverticulitis  and  cancer:  Al- 
though the  simultaneous  occurrence  of  these 
two  processes  is  rare'"'7"1,  the  problem  of  dif- 
ferentiation arises  often.  The  problem  has 
been  touched  on  under  "Hemorrhage,"  for 
here  the  suspicion  of  malignancy  is  great. 
The  distinction  may  also  be  difficult  in  the 
other  classes — for  example,  acute  sigmoid- 
itis with  obstruction,  or  even  perforation. 
X-ray  examination  is  the  best  method  of  es- 
tablishing the  true  diagnosis,  for  there  are 
some  very  definite  differences  in  the  appear- 
ance of  malignancy  as  contrasted  with  that 
of  the  complications  of  diverticulosis14'. 
Even  so,  in  a  high  percentage  of  cases  the 
diagnosis  is  not  known  until  operation  or 
even  until  a  microscopic  report  is  rendered 
.71..  i::,  por  this  reason  the  colon  specimen 
should  be  opened  in  the  operating  theater 
to  be  certain  that  a  malignancy  has  not  been 
overlooked  and  inadequately  resected. 


Treatment 

Treatment  in  any  case  of  acute  diverticu- 
lar disease  must  be  sensibly  individualized, 
because,  as  stated  earlier,  any  one  case  may 
present  some  aspect  of  any  or  all  of  our  arbi- 
trary classification. 

1.  Acute  sigmoiditis  without  sufficient  re- 
action to  produce  either  paralytic  ileus  or 
progression  or  obstruction  can  be  treated 
by  a  nonoperative  regimen  such  as  bed  rest, 
antispasmodics,  oral  liquids,  stool  softeners, 
and  intestinal  antiseptics.  The  preferred 
antibiotics  range  from  sulfasuxidine  to  a 
combination  of  penicillin-streptomycin.  If 
the  condition  progresses  under  this  program, 
therapy  must  be  stepped  up  to  nothing  in- 
gested by  mouth,  nasogastric  suction,  paren- 
teral fluids,  parenteral  antispasmodics,  and 
parenteral  antibiotics.  If  the  inflammatory 
process  is  checked,  prophylactic  resection 
should  be  seriously  considered.  If  on  the 
other  hand  the  process  is  not  checked  and 
further  complications  loom,  a  loop  colostomy 
should  be  carried  out  in  the  right  transverse 
colon  with  elective  sigmoid  resection  in  four 
to  eight  weeks. 

Whenever  a  case  of  acute  diverticular  dis- 
ease progresses  to  the  point  that  a  colostomy 
is  necessary,  then  the  involved  bowel  should 
be  resected  before  the  colostomy  is  closed15"' 
iia,  i3,  if..  At  resection  it  is  not  necessary  to 
remove  all  of  the  colon  containing  diverti- 
cula, but  it  is  essential  that  the  entire  sig- 
moid be  removed  lest  residual  sigmoid  di- 
verticula lead  to  recurrent  diverticulitis'171. 

One  other  operative  approach  to  acute  sig- 
moiditis needs  to  be  mentioned :  the  acute 
sigmoiditis  found  unexpectedly  at  operation. 
In  this  situation  several  methods  of  handling 
diseased  bowel  are  available:  an  exteriori- 
zation procedure,  formation  of  a  proximal 
colostomy,  or  a  delayed  one-stage  resection 
after  preparation. 

2.  Perforation  of  a  diverticulum  of  the 
colon  is  best  treated  by  a  proximal  colostomy 
and  drainage  of  the  pelvis.  No  effort  should 
be  made  to  track  down  the  exact  spot  of 
leakage  with  an  attempt  to  oversew  the 
opening  in  inflamed  and  necrotic  tissues.  Ex- 
teriorization of  the  diseased  colon  segment 
has  been  carried  out,  and  even  a  nonopera- 
tive technique  has  been  used,  but  proximal 
colostomy  and  drainage  is  safest.  Again, 
once  the  diverticular  disease  has  progressed 
to  the  point  of  rupture,  resection  should  be 
the  ultimate  goal. 


August,  19G0 


SYMPOSIUM  ON  ACUTE  CONDITIONS  OF  THE  ABDOMEN 


325 


3.  Hemorrhage  from  diverticular  disease 
with  or  without  inflammation  will  often  sub- 
side on  nonoperative  measures11"'.  This  then 
allows  for  an  elective  resection  on  a  proper- 
ly prepared  bowel.  A  nonoperative  measure 
which  may  produce  a  dramatic  cessation  of 
bleeding  is  the  barium  enemallS).  Presum- 
ably the  barium  enters  the  offending  diverti- 
cula and  produces  a  tamponade  effect.  The 
minority  of  patients  who  do  not  stop  bleed- 
ing on  a  nonoperative  approach  will,  of 
course,  require  an  emergency  colon  resec- 
tion.   These  are  usually  older  patients(Ub). 

4.  Acute  diverticulitis  with  small  boivel 
obstruction  must  be  recognized  and  not 
treated  by  proximal  colostomy  alone  for  ob- 
vious reasons'91.  Intensive  nonoperative 
treatment  may  be  condoned  for  24  or  even 
48  hours  if  the  obstruction  seems  to  be  par- 
tial and  possibly  due  to  exudation  and  edema. 
If  there  is  no  relief  of  the  obstruction  or  if 
the  obstruction  recurs,  it  is  necessary  to 
form  a  colostomy  and  free  the  small  bowel 
obstruction. 

5.  Acute  diverticulitis  with  fistula  or  sinus 
formation  should  be  treated  by  a  proximal 
colostomy  and  eventual  resection  of  the  dis- 
eased colon.  Simple  dissection  of  a  colo-cut- 
aneous  sinus  or  a  colon  fistula  with  closure 
invites  a  recurrence.  Also,  to  close  the  prox- 
imal colostomy  without  resecting  the  dis- 
eased colon  in  cases  of  fistula  and  sinus  in- 
vites recurrence113'. 

6.  Acute  diverticiditis  and  cancer  produce 
a  much  greater  sense  of  urgency  to  proceed 
to  wide  resection  of  the  involved  bowel.  Ear- 
ly proximal  colostomy  may  diminish  the  in- 
flammation more  quickly  than  a  nonopera- 
tive approach,  and  resection  may  be  carried 
out  within  two  to  three  weeks,  leaving  the 
proximal  colostomy  as  a  protection  against 
suture  line  leakage. 

Summary 
Acute  effects  or  complications  of  diverti- 
culosis  coli  have  been  arbitrarily  divided 
into :  acute  sigmoiditis,  perforation,  hemor- 
rhage, acute  diverticulitis  with  small  bowel 
obstruction,  acute  diverticulitis  with  sinus  or 
fistula  formation,  and  acute  diverticulitis 
with  associated  malignancy.  Some  sugges- 
tions have  been  made  as  to  the  methods  of 
diagnosing  and  treating  these  complications. 
The  nearest  common  denominator  seems  to 
be  that  the  more  frequently  we  resect  the 
colon  in  symptomatic,  progressive  diverticu- 
lar disease,  the  less  often  these  complications 
will  have  to  be  treated. 


References 

1.  (a)  Degenshein,  G.  A.:  Diverticulitis  of  the  Right  Colon. 
A.  M.  A.  Arch.  Surg.  76:  564-568  (April)  1958.  (b)  Mann, 
R.  W.:  Solitary  Cecal  Diverticulitis.  A.  M.  A.  Arch. 
Surg.  76:  527-529  (April)  1958.  (c)  Zinninger.  M.  M. : 
Dlvertlculosis  and  Diverticulitis  of  the  Colon,  Am. 
Surgeon  22:   683-695    (Aug.)    1956. 

2.  Littlefleld,  J.  B.:  Surgical  Complications  of  Diverti- 
culitis and  Dlvertlculosis  of  the  Sigmoid  Colon,  Am. 
Surgeon    23:    272-277    (March)    1957. 

3.  (a)  Smithwick,  R.  H.:  Experiences  with  the  Surgical 
Management  of  Diverticulitis  of  the  Sigmoid.  Ann. 
Surg.  115:  969-985  (June)  1942.  (b)  Spriggs,  E.  I.,  and 
Marxer,  O.  A.:  Multiple  Diverticula  of  the  Colon,  Lancet 
1:   1067-1074   (May  21)    1927. 

4.  Mayo,  C.  W.,  and  Blunt,  C.  P.:  The  Surgical  Manage- 
ment of  the  Complications  of  Diverticulitis  of  the 
Large  Intestine:  Analysis  of  202  Cases,  S.  Clin.  North 
America  30:    1005-1012    (Aug.)    1950. 

5.  (a)  Boyden,  A.  M.:  The  Surgical  Treatment  of  Diverti- 
culitis of  the  Colon,  Ann.  Surg.  132:  94-109  (July) 
1950.  (b)  Jones,  T.  E.:  Diverticulitis  and  Diverticu- 
losis  of  the  Colon,  S.  Clin.  North  America  19:  1105- 
1117    (Oct.)    1939. 

6.  Jones,  T.  E. :  Surgical  Treatment  of  Diverticulitis,  Ohio 
State  M.   J.  34:   1225-1223   (Nov.)    1938. 

7.  (a)  McGowan,  F.  J.,  and  Wolff,  W.  I.:  Diverticulitis 
of  the  Sigmoid  Colon,  Gastroenterology  21:  119-132 
(May)  1952.  (b)  McMillan,  F.  L.,  and  Jamieson,  R.  W.: 
Trends  in  the  Surgical  Treatment  of  Diverticulitis  of 
the  Colon,  S.  Clin.  North  America  35:  153-173  (Feb.) 
1955. 

8.  Horner,  J.  L.:  Natural  History  of  Diverticulosis  of  the 
Colon,   Am.   J.   Dig.   Dis.   3:   343-350   (May)    1958. 

9.  Bodon,  G.  R.,  and  Lapuz,  B.:  Acute  Small  Bowel  Ob- 
struction with  Sigmoid  Diverticulitis  and  Its  Manage- 
ment, Surgery  44:  631-635   (Oct.)    1958. 

10.  Fitts,  W.  T.,  Jr.,  and  Anderson,  L.  D. :  Spontaneous 
Perforation  of  Sigmoid  Colon  in  Presence  of  Diverticu- 
losis; Report  of  2  Cases  Without  Evidence  of  Inflamed 
Diverticula,   J.  A.  M.   A.   152:   1427-1428    (Aug.  8)    1953. 

11.  (a)  Bacon,  H.  E.,  and  Valiente,  M.  A.:  Surgical  Man- 
agement of  Diverticulitis,  Am.  J.  Surg.  91:  178-183 
(Feb.)  1956.  (b)  Earley,  C.  M.,  Jr.:  The  Management 
of  Massive  Hemorrhage  from  Diverticular  Disease  of 
the  Colon,  Surg.  Gynec.  &  Obst.  108:  49-60  (Jan.)   1959. 

12.  Morton,  J.  J.,  Jr.:  Diverticulitis  of  the  Colon,  Ann. 
Surg.    124:    725-745    (Oct.)    1946. 

13.  Colcock,  B.  P.:  Surgical  Management  of  Complicated 
Diverticulitis,  New  England  J.  Med.  259:  570-573  (Sept. 
IS)    1958. 

14.  (a)  Lynn,  T.  E.,  Farrell.  J.  I.,  and  Grier,  J.  P.:  Sig- 
moidovesical  Fistula  Secondary  to  Diverticulitis,  A.  M. 
A.  Arch.  Surg.  76:  956-962  (June)  1958.  (b)  Judd,  E.  S., 
and  Smith,  M.  P.:  Present  Trends  in  Surgical  Treat- 
ment of  Diverticulitis,  S.  Clin.  North  America  37:  1019- 
1027    (Aug.)    1957. 

15.  Cripps,  H.:  Cited  by  Mayfield,  L.  H.,  and  Waugh. 
J.  M.:  Sigmoidovesical  Fistulae  Resulting  from  Di- 
verticulitis of  the  Sigmoid  Colon,  Ann.  Surg.  130: 
186-199    (Aug.)    1949. 

16.  Smithwick,  R.  H.:  Surgical  Treatment  of  Diverticul- 
itis of  the  Sigmoid,  Am.  J.  Surg.  99:  192-205  (Feb.)  1960. 

17.  Turnbull,  R.   P.:   Personal   Communication. 

18.  Meyer,  T.  L. :  Massive  Hemorrhage  from  Sigmoid  Di- 
verticula,  Am.  J.  Surg.   99:   251-252   (Feb.)    1960. 

19.  Colcock,  B.  P.:  Surgical  Treatment  of  Diverticulitis, 
Am.   Surgeon  24:   738-740    (Oct.)    1958. 


326 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,  1960 


Diagnosis  and  Treatment  of  Acute  Cholecystitis 


William  W.  Shingleton,  M.D.* 
Durham 


Because  of  the  rapidly  increasing  number 
of  older  people  in  the  population,  the  inci- 
dence of  complications  arising  from  chronic 
biliary  tract  disease  is  on  the  increase. 
Among  these  complications  is  acute  cholecy- 
stitis. For  example,  during  a  26-year  period 
(1932-1958)  at  the  New  York  Hospital, 
5,037  operations  were  performed  for  non- 
malignant  biliary  tract  disease,  1,028  of 
which  were  for  acute  cholecystitis111.  It  has 
been  estimated  that  approximately  10  per 
cent  of  the  entire  population  have  gallstones, 
and  the  incidence  is  about  four  times  as  fre- 
quent in  women  as  in  men'2'.  Approximately 
10  per  cent  of  these  patients  may  be  ex- 
pected to  develop  acute  cholecystitis. 

The  etiology  of  gallstone  formation  is  still 
unknown  in  spite  of  intensive  research. 
Neither  is  the  mechanism  of  the  development 
of  acute  cholecystitis  completely  understood. 
A  common  clinical  finding  in  acute  cholecy- 
stitis, however,  is  the  presence  of  an  im- 
pacted stone  producing  obstruction  of  the 
cystic  duct.  Although  acute  cholecystitis  may 
occur  in  the  absence  of  cholelithiasis,  this  is 
the  exception  and  not  the  rule.  Most  stu- 
dents of  the  disease  feel  that  with  obstruc- 
tion of  the  cystic  duct,  the  concentration  of 
bile  in  the  obstructed  gallbladder  is  in- 
creased, giving  rise,  initially,  to  a  chemical 
inflammatory  reaction,  resulting  in  edema  of 
the  wall  of  the  organ.  This,  in  turn,  leads 
to  impairment  of  the  circulation  and  event- 
ual invasion  of  the  damaged  tissue  by  bac- 
teria. Although  bacteria  can  conceivably 
enter  the  organ  from  the  blood  stream  by 
direct  invasion  from  adjacent  organs  or 
originate  from  the  bile,  evidence  suggests 
that  the  bacterial  invasion  occurs  most  often 
via  the  lymphatic  vessels'21.  Bacteria  can  be 
cultured  from  approximately  50  per  cent  of 
acutely  inflamed  gallbladders,  and  the  most 
common  organisms  recovered  are  Esche- 
richia coli  and  streptococci1'". 

Diagnosis 

Cholecystography  provides  the  single  most 
helpful  procedure  in  establishing  the  pres- 
ence or  absence  of  chronic  gallbladder  dis- 
ease.   The  most  helpful  diagnostic  procedure 


'From   the  Department   of   Surgery.    Duke   University   Med- 
ical Center,  Durham,  North  Carolina. 


in  acute  cholecystitis,  however,  is  the  phys- 
ical examination  of  the  patient.  The  symp- 
toms are  strikingly  uniform  in  a  majority 
of  cases. 

The  attack  usually  begins  with  the  devel- 
opment of  moderately  severe  epigastric  or 
right  upper  quadrant  pain,  often  radiating 
to  the  back,  scapula  area,  or  right  shoulder. 
The  pain  is  usually  quite  severe,  requiring 
narcotics  for  relief,  and  is  usually  associated 
with  nausea  and  vomiting.  Chills  and  fever, 
or  fever  alone,  develop  during  the  attack. 

The  physical  signs  consist  of  tenderness, 
muscle  spasm,  and  rebound  tenderness  in  the 
right  upper  quadrant ;  there  is  often  a  pal- 
pable mass  in  this  area,  representing  the 
distended  gallbladder.  A  mild  jaundice  is 
often  present.  If  perforation  of  the  gallblad- 
der has  occurred,  a  palpable  mass  represent- 
ing a  walled-off  abscess,  or  generalized  peri- 
toneal signs  representing  a  bile  peritonitis, 
will  be  present. 

Laboratory  studies  in  acute  cholecystitis 
reveal  a  leukocytosis  and,  in  some  cases,  mild 
elevation  of  serum  bilirubin.  Serum  amylase 
may  be  elevated  in  cases  associated  with  pan- 
creatitis, which  is  usually  of  the  edematous 
variety.  An  intravenous  cholangiogram  may 
result  in  visualization  of  the  common  duct 
but  non-filling  of  the  gallbladder'4'. 

Acute  cholecystitis  must  be  differentiated 
from  other  acute  abdominal  inflammatory 
conditions,  such  as  perforated  duodenal  ul- 
cer, acute  cholecystitis,  acute  pancreatitis, 
acute  diverticulitis,  hepatitis,  and  abscess  of 
the  liver.  Renal  disease  and  coronary  throm- 
bosis also  should  be  included  in  the  differ- 
ential diagnosis. 

Treatment 

The  patient  with  acute  cholecystitis  may 
be  treated  with  or  without  operation  during 
the  acute  attack.  Although  certain  physi- 
cians may,  by  choice,  treat  all  their  cases  by 
one  or  the  other  of  the  two  methods,  many 
now  hold  that  the  method  chosen  be  fitted  to 
the  individual  patient,  based  upon  consider- 
ation of  a  variety  of  factors  bearing  upon 
the  mortality  and  morbidity  of  the  disease. 
Some  of  the  factors  are: 

1.  The  duration  of  symptoms  when  the 
patient  is  first  seen 


AuKust,  1960 


SYMPOSIUM  ON  ACUTE  CONDITIONS  OF  THE  ABDOMEN 


327 


2.  The  accuracy  of  diagnosis 

3.  Age  of  the  patient 

4.  Presence  of  associated  disease 

5.  Severity  of  the  disease  when   patient 
is  first  seen. 

Prevailing  opinion  holds  that  operation 
can  be  carried  out  in  a  majority  of  patients 
during  the  early  stages  (48  to  72  hours)  of 
acute  cholecystitis  with  a  low  mortality  and 
morbidity,  and  with  a  shorter  hospital  stay. 
Large  groups  of  patients  treated  by  both 
surgical  and  nonsurgical  methods  with  no 
striking  difference  in  mortality  have  been 
reported.  Thus  Bartlett1"  reported  on  592 
patients  treated  surgically  and  124  patients 
treated  nonsurgically  at  the  Massachusetts 
General  Hospital  with  a  mortality  rate  of  3 
per  cent  in  the  surgical  cases  and  4  per  cent 
in  the  nonsurgical  cases.  Becker";'  reported 
on  679  patients  treated  surgically  and  381 
patients  treated  nonsurgically  at  the  Charity 
Hospital  in  New  Orleans.  The  mortality  rate 
in  the  surgical  group  was  6.6  per  cent,  and 
in  the  nonsurgical  5.5  per  cent. 

The  types  of  operative  procedures  usually 
employed  are  cholecystectomy,  cholecystec- 
tomy and  choledochostomy,  and  cholecystos- 
tomy.  The  incidence  of  exploration  of  the 
common  duct  during  operation  as  reported 
by  several  authors'"''71  varies  between  10 
and  40  per  cent.  It  is  suggested  that  the 
following  conditions  constitute  indications 
for  exploration  of  the  common  bile  duct  dur- 
ing operation  for  acute  cholecystitis : 

1.  Palpable  stone  in  duct 

2.  Jaundice  with   bilirubin   above   5   mg. 
per  100  ml. 

3.  Associated  pancreatitis. 

It  should  be  pointed  out  that  if  the  inflam- 
matory reaction  around  the  common  duct 
abscures  anatomic  identification  of  struc- 
tures in  the  area,  exploration  of  the  common 
duct,  even  when  indications  exist,  may  be 
deferred  and  performed  as  a  secondary  pro- 
edure  later. 

Cholecystostomy  is  used  in  the  acutely  ill 
3r  poor  risk  patient  who  fails  to  respond  to 
lonoperative  treatment.  The  procedure  can 
ae  carried  out  under  local  anesthesia  with 
only  slight  risk  and  may  be  life-saving  in  this 
eriously  ill  group. 

The  complication  to  be  avoided,  if  at  all 
possible,  is  perforation  of  the  gallbladder 
prior  to  surgical  intervention.  At  one  time 
this  complication  was  considered  rare ;  how- 
3ver,  the  several  reported  series  suggests 
that  it  develops  in  10  to  25  per  cent  of  pa- 


tients with  acute  cholecystitis"1.  Three  types 
of  perforations  occur:  (1)  perforation  into 
the  free  peritoneal  cavity,  the  most  serious; 
(2)  perforation  with  walled-off  abscess,  the 
least  serious;  and  (3)  perforation  into  an 
adjacent  viscus,  often  the  colon.  The  man- 
agement of  perforation  with  generalized 
peritonitis  is  cholecystectomy  with  drainage 
of  the  peritoneal  cavity.  The  treatment  of 
perforation  with  localized  abscess  is  initially 
a  nonoperative  program  including  stomach 
suction,  antibiotics,  and  intravenous  fluids. 
Interval  cholecystectomy  should  be  carried 
out  later.  Treatment  of  perforation  into  an 
adjacent  viscus  consists  of  cholecystectomy 
with  repair  of  the  perforation  into  the  in- 
volved viscus. 

The  principles  of  nonsurgical  treatment 
are  bed  rest,  stomach  suction,  antibiotics, 
and  intravenous  fluids  and  electrolytes.  This 
treatment  should  be  continued  until  the  pa- 
tient is  pain-free  and  the  temperature  and 
leukocyte  count  have  returned  to  normal. 

An  interesting  approach  with  which  the 
author  has  had  no  experience  is  the  use  of 
procaine  block  of  perirenal  or  splanchnic 
nerve.  A  Russian  surgeon,  Ossipov'91,  has 
recently  reported  on  this  technique.  It  is 
my  opinion  that,  as  in  acute  pancreatitis, 
regional  procaine  injection  in  acute  cholecys- 
titis favorably  influences  the  acute  inflam- 
matory process.  Patients  are  initially  given 
a  paranephric  procaine  block,  some  of  which 
respond  (no  figures  given)  ;  those  who  do 
not  respond  are  operated  on  during  the  first 
24  hours,  under  local  anesthesia.  Under  this 
method  there  were  9  deaths  in  285  opera- 
tions, a  mortality  rate  of  3.1  per  cent. 

Experience  at  Duke  Hospital 

The  charts  of  100  consecutive  cases  of 
acute  cholecystitis  treated  at  Duke  Hospital 
from  1953  through  1959  were  recently  re- 
viewed. Fifty-one  patients  were  operated 
on  during  the  acute  attack,  and  49  patients 
were  treated  nonoperatively.  Thirty-one 
were  males  and  69  were  females.  Forty-two 
patients  were  under  50  and  58  patients  were 
over  50  years  of  age.  Twenty-one  patients 
were  over  70  years  of  age  and  seven  patients 
were  over  80.  Operation  was  carried  out  in 
the  following  circumstances : 

1.  In  patients  seen  early  in  the  disease 
(48  hours)  who  were  good  or  reason- 
able surgical  risks 

2.  In  patients  where  diagnosis  was  in 
doubt 


:;l'n 


NORTH  CAROLINA  MEDICAL  JOURNAL 


August,  10(30 


4. 


In  patients  who  did  not  respond  or 
grew  worse  during  medical  treatment 

In  patients  who  exhibited  signs  of  im- 
pending or  actual  perforation  of  the 
gallbladder. 


The  results  of  treatment  and  type  of  op- 
erative procedure  used  in  the  100  cases  of 
acute  cholecystitis  are  shown  in  table  1.  One 
of  the  deaths  in  the  surgically  treated  group 
resulted  from  cardiac  arrest  which  developed 
during  operation,  and  autopsy  showed,  in 
addition  to  acute  cholecystitis,  marked  cor- 
onary atherosclerosis.  The  other  death  in 
the  surgical  group  occurred  in  a  patient  who 
had  acute  cholecystitis  five  days  following 
inferior  vena  caval  ligation  for  multiple  pul- 
monary embolism.  The  patient  was  operated 
on  24  hours  following  the  onset  of  abdom- 
inal symptoms  and  was  found  to  have  a  per- 
forated gallbladder,  which  was  removed.  The 
patient  died  two  days  later,  presumably  from 
peritonitis ;  no  autopsy  was  obtained. 

The  one  death  in  the  nonoperatively 
treated  group  occurred  in  a  patient  who  was 
admitted  to  the  hospital  with  signs  of  gen- 
eralized peritonitis  and  who  died  24  hours 
later.  The  cause  of  the  peritonitis  was  not 
established  prior  to  death.  Autopsy  revealed 
a  generalized  bile  peritonitis  from  perfora- 
tion of  an  acutely  inflamed  gallbladder. 

Certain  associated  diseases  encountered 
in  the  100  patients  treated  for  acute  cho- 
lecystitis are  of  interest.  Five  patients  had 
acute  pancreatitis.  All  these  patients  had  a 
serum  amylase  level  above  500  Somgyi  units 
when  first  seen  before  operation.  Operation 
was  deferred  in  all  these  patients  during  the 
acute  attack.  Three  patients  were  found  to 
have  carcinoma  of  the  pancreas  in  conjunc- 
tion with  acute  cholecystitis.  In  one  case 
acute  cholecystitis  developed  after  an  opera- 
tion for  an  unassociated  condition. 

Summary  and  Co)iclusions 

A  review  of  the  diagnostic  features  of 
acute  cholecystitis  is  presented.  Diagnosis 
can  be  established  in  a  majority  of  patients 
early  in  the  acute  attack.  The  most  helpful 
diagnostic  procedure  is  accurate  observation 
of  physical  signs  associated  with  the  disease. 
Intravenous  cholangiography  performed 
during  an  acute  attack  may  be  helpful. 


No. 

eaths 

Mortality 

1 

2', 

2 

■I'; 

1 

0 

0 

1 

Table    1 
Mortality  in  Surgical  and   Nonsurgical  Treatment 
of  Acute  Cholecystitis 
No. 

Treatment  Cases 

Nonoperative    _  49 

Operative 51 

Cholecystectomy 40 

Cholecystectomy    6 

Cholecystectomy   \    , 

Choledochostomy    / 

Cholecystostomy    5 

Results  of  treatment  in  acute  cholecysti- 
tis, as  reported  in  current  medical  literature, 
suggest  that  patients  can  be  treated  both  op- 
eratively  and  nonoperatively  with  a  similar 
mortality. 

A  review  of  100  consecutive  patients  with 
acute  cholecystitis  treated  at  Duke  Hospital 
from  1953  through  1959  shows  that  approx- 
imately one  half  of  the  patients  were  op- 
erated upon  during  the  acute  attack,  and 
the  other  half  were  treated  nonoperatively 
Mortality  rates  were  similar  in  the  two 
groups.  The  indications  for  operation  and' 
management  of  complications  are  discussed 
It  is  concluded  that  treatment  of  patients 
should  be  individualized,  and  that  the  form 
of  treatment  chosen  should  be  that  which  is 
best  suited  to  the  specific  situation  in  each! 
individual  case. 

References 

1.  Glenn.  P.:  A  26  Year  Experience  in  the  Surgical  Treat 
ment  of  5.037  Patients  with  Nonmallgnant  Biliarj 
Tract  Disease,   Surg..  Gynec.  &  Obst.,   109:   591.   1959 


: 
Iter 


2.  Cole,  W.  H..  and  Elman,  R:  Textbook  of  Surgery 
New  York,   Appleton-Century-Crofts.   Inc. 

3.  Illingworth,  C.  F.  W.  Types  of  Gallbladder  Infection 
Brit.  J.  Surg..   15:  221.   1928. 

4.  Sparkman.  R.  S..  and  Ellis.  P.  R.:  Intravenous  Cho 
lecyst-Cholangiography  in  Emergency  Abdominal  Di 
agnosis,  Ann.  Surg.  143:  416-421   (March)   1956. 

5.  Bartlett.  M.  K..  Quinby.  W.  C.  and  Donaldson,  G.  A. 
Surgery  of  the  Biliary  Tract:  Treatment  of  Acute  Cho 
lecystltis.  New  England  J.  Med.  254:  200-205  (Feb.  2: 
1956. 

6.  Becker.  W.  F.:  Powell.  J.  L.;  Turner.  R,  J.:  A  Clinica; 
Study  of  1060  Patients  with  Acute  Cholecystitis.  Surg.i 
Gynec.  &  Obst.   104:491.   1957. 

7.  (a).  Boyden.  A.  M.:  Acute  Gallbladder  Disease  and  th 
Common  Duct,  A.  M.  A.  Arch.  Surg.  70:  374-378  (March 
1955. 

(b).  Dunphy,  J.  E..  and  Ross.  F.  P.:  Studies  in  Acut; 
Cholecystitis:  Surgical  Management  and  Results,  Sur 
gery,  26:  539-547   (Sept.)    1949. 

ic).  Glenn.  F. :  Common  Duct  Exploration  in  Acut 
Cholecystitis,    Surg,.    Gynec,    and   Obst.,    104:    190.    195' 

8.  Pines,  B..  and  Rabinovltch,  J. :  Perforation  of  the  Gall 
bladder  in  Acute  Cholecystitis.  Ann.  Surg.  10:  170-17 
(Aug.)    1954. 

9.  Osipov,  B.  K.:  The  Surgeon's  Tactics  in  the  Treatmen 
of  Acute   Cholecystitis,    Surgery   46:   507,    1959. 


!k 

[mli 
il 

a  ci 
. 


':■.':' 


I,  SO' 


-■v 
torn; 


August,  1960 


329 


Acute  Surgical  Conditions 
Associated  with  Pelvic  Endometriosis 


Robert  A.  Ross,  M.D.* 
Chapel  Hill 


The  problem  of  endometriosis  deserves 
deliberate  consideration  in  a  symposium 
dealing  with  acute  surgical  conditions  of  the 
abdomen.  The  "acute  abdomen"  generally 
is  well  understood  and  its  importance  recog- 
nized. Though  the  qualified  surgeon  is  capa- 
ble of  meeting  emergencies  as  they  arise, 
anticipating  the  correct  diagnosis  allows  for 
I  better  preoperative  care,  better  definitive 
I  measures,  and  greater  assurance  that  the 
9  patient  will  be  maintained  as  a  normal  an- 
>  atomic,  biologic,  and  psychologic  woman. 

Diagnostic  Criteria 
The  compelling  reason  for  placing  a  case 

oil  of  endometriosis  in  the  category  of  surgical- 
ly acute  conditions  would  probably  be  one 
or  a  combination  of  several  symptoms  and 
findings :  Intra-abdominal  bleeding,  intesti- 
nal obstruction,  lower  abdominal  infection, 
bleeding  from  the  urinary  tract,  and  rectal 
bleeding  are  the  most  common  in  the  acutely 
ill  patient.  The  patient  would  likely  be  in 
the  20-  to  40-year  age  group ;  she  would  give 
a  history  of  increasing  dysmenorrhea  or  ac- 
quired dysmenorrhea ;  the  menstrual  cycle 
probably  would  have  been  altered ;  if  mar- 
ried, she  might  give  a  history  of  sterility ; 
previous  uterine  currettement  or  pelvic  op- 
erations are  not  uncommon.  The  patient 
must  have  or  have  had  a  uterus  and  func- 

.  tioning  ovarian  tissue  in  order  to  have  en- 

d  dometriosis ;  however,  intestinal  obstruction 
can  occur  after  castration  or  hysterectomy 
in  patients  who  have  had  proven  endometri- 
osis. 

The  acute  symptom  or  symptoms  are  eas- 
ier to  explain  than  those  of  chronic  or  pro- 

;:  gressing  pelvic  endometriosis.  A  transplant 
to  the  ovary  can  rupture,  giving  signs  and 

..symptoms  similar  to  an  ectopic   pregnancy 

:i  or  bleeding  from  a  ruptured  graffian  follicle ; 
or  it  can  become  twisted,  thus  actually  be- 

'".'',  coming  a  twisted  ovarian  cyst  with  the  re- 
lated  complications :   old  blood  and   cellular 

;  material  can  escape  from  an  area  of  endom- 
etrial transplants  and  give  all  the  evidence 

:'~;  of  acute  appendicitis  or  salpingitis,  or  such 


*From    the    Department    of    Obstetrics    and    Gynecology,    Uni- 
versity   of    North    Carolina    School    of    Medicine.     Chapel    Hill. 


areas  can  themselves  become  infected.  Large 
and  small  intestines  can  become  adherent  to 
endometrial  nodules  with  resulting  intestinal 
obstruction,  or  the  process  can  involve  the 
bowel  wall,  usually  rectosigmoid,  and  grad- 
ually produce  obstruction.  In  two  instances 
we  have  been  confronted  with  hematuria 
and  ureteral  pain  with  symptoms  similar  to 
renal  calculus  and  have  found  endometrioma 
of  the  broad  ligament  and  pelvic  brim  with 
hemorrhage. 

Abdominal  palpation  or  auscultation  yields 
little  that  is  distinctive.  Pelvic  examination, 
however,  may  disclose  something  that  could 
suggest  pelvic  endometriosis.  Tenderness 
and  "beading"  of  the  uterosacral  ligaments 
is  a  common  finding,  and  there  is  usually 
more  fixation  of  the  uterus  and  adnexae 
than  one  finds  certainly  in  appendicitis  or  in 
a  patient  with  initial  salpingo-oophoritis. 
Although  bilaterality  is  common  in  the  dis- 
ease, usually  one  ovary  and  tube  is  more  ad- 
herent than  the  other.  The  rectovaginal  sep- 
tum may  be  obliterated,  is  unusually  tender, 
or  perhaps  has  findings  similar  to  ruptured 
ectopic  pregnancy.  Rarely,  a  suggestive  spot 
is  encountered  on  the  cervix  or  vaginal  mu- 
cosa that  would  add  to  the  suspicion  of 
endometriosis,  but  this  sign  is  uncommon. 

Treatment 
The  management  of  these  acute  complica- 
tions of  endometriosis  is  surgical,  but  con- 
servative treatment  is  usually  possible.  The 
conservation  of  ovarian  tissue  and  an  at- 
tempt to  preserve  and  promote  fertility  is 
laudable  and  often  rewarding.  Endometri- 
osis is  one  of  the  few  conditions  in  which 
"piecemeal"  surgery  in  the  pelvis  is  justi- 
fied. An  infected  endometrioma  is  excised, 
usually  without  drainage ;  a  bleeding  area 
is  usually  removed ;  when  intestines  ai*e  ad- 
herent or  kinked,  they  are  freed  and  the 
implants  excised  or  fulgurated ;  when  pelvic 
viscera  are  distorted,  they  are  replaced  and 
raw  areas  protected.  If  the  patient's  con- 
dition is  satisfactory  and  if  she  has  had  se- 
vere dysmenorrhea,  pre-sacral  neurectomy 
could  be  included  and  will  often  give  grati- 
fying relief.  Prolapsed  and  adherent  ovaries 
and   tubes   should   be   freed   and   suspended 


:;::u 


NORTH   CAROLINA   MEDICAL  JOURNAL 


Aue-ust,  ItiCO 


with  minimal  trauma.  A  uterus  that  is  path- 
ologically fixed  in  retroversion  might  offer 
one  of  the  few  remaining  justifications  for 
the  procedure  of  uterine  suspension. 

Endometrioma  of  the  bladder  and  rectum, 
usually  the  anterior  wall,  sometimes  are  so 
extensive  that  partial  resection  of  the  viscus 
is  necessary  for  relief;  and  if  the  process  is 
quite  extensive,  castration  might  be  neces- 
sary. If  in  doubt,  one  is  usually  safe  in  being 
conservative,  since  castration  can  later  be 
accomplished  by  x-ray. 

Culdoscopy  carries  a  hazard  in  extensive 
pelvic  endometriosis  and  is  of  value  chiefly 
in  the  differential  diagnosis  of  obscure  pelvic 


complaints  with  little  or  no  palpatory  find- 
ings. 

Conclusion 

In  a  discussion  dealing  primarily  with  the 
acute  complications  possible  in  pelvic  en- 
dometriosis, it  is  not  necessary  to  outline  the 
ideas  regarding  histogenesis  nor  to  relate 
the  most  recent  studies  of  the  response  to 
endocrine  therapy.  The  background  and 
current  management  of  this  condition  make 
fascinating  study.  Such  a  study  is  definitely 
warranted  in  the  effort  to  reduce  the  increas- 
ing incidence  of  this  crippling  lesion. 


Medical  and  Hospital  Costs  of  the  Aged 
A  Current  Appraisal 


Walter  Polmer,  Ph.D. 
Madison,  Wisconsin 


The  medical  profession  is  now  facing  a 
problem  which  it  has  to  a  large  extent  cre- 
ated. The  United  States  has  a  population 
of  more  than  175  million  persons,  of  whom 
16  million  are  aged  65  years  and  over.  The 
persons  in  this  age  group  are  increasing  at 
about  twice  the  rate  of  the  over-all  popu- 
lation. 

Wherever  one  turns  in  the  literature  on 
aging  there  echoes  the  theme  crisply  stated 
by  Piersol  and  Bortz  in  the  late  1930's :  "The 
society  which  fosters  research  to  save  human 
life  cannot  escape  responsibility  for  the  life 
thus  extended.  It  is  for  science  not  only  to 
add  the  years  to  life-  but  more  important  to 
add  life  to  the  yeai-s."  But  will  the  added 
years  of  life  be  burdened  by  disease,  illness, 
disability,  and  high  medical  costs? 

Persons  aged  65  years  and  over  are  be- 
coming increasingly  aware  of  the  value  of 
good  medical  care.  Certainly  they  have  rea- 
son to  be  thankful  for  this  type  of  medical 
care.  In  the  past,  pain,  disability,  and  seri- 
ous illness  involved  relatively  little  expense, 
because  there  was  little  that  could  be  done 
for  a  sick  person.  Now  pain  and  disability 
can  often  be  avoided  and  death  significantly 
postponed,  but  at  the  cost  of  more  visits  to 
the  physician,  more  admissions  to  hospitals, 
more  use  of  drugs  and  other  treatments.  All 
these  medical  expenses  must  be  met  either  by 
the  elderly  patient,  his  family,  the  physician, 


the  hospital,  or  society.  In  the  light  of  de- 
creasing mortality  among  the  middle-aged 
and  the  aged,  the  recent  increases  in  the  cost 
of  medical  care  do  not  seem  excessive.  In 
fact,  some  authorities  believe  that  we  do  not 
yet  spend  enough  for  health  care. 

Rising  Expenditures  for  Medical  Care 

As  part  of  their  rising  standard  of  living 
today,  the  American  people  are  spending 
more  money  on  medical  care  than  ever  be- 
fore. Part  of  the  increase  reflects  popula- 
tion growth  and  rising  prices ;  even  on  a  per 
capita  basis  and  with  prices  held  constant, 
medical  spending  has  increased.  For  this 
large  outlay,  the  American  consumer  today 
receives  a  greater  quantity  and  variety  of 
improved  medical  services. 

Studies  by  the  Health  Information  Foun- 
dation indicate  that  in  1929  Americans  spent 
$3  billion  for  medical  care.  Over  the  next 
four  years,  as  economic  activity  contracted, 
annual  expenditures  dropped  by  about  one- 
third,  reaching  just  below  $2  billion  in  1933. 
Expenditures  for  medical  care  have  in 
creased  each  year  since  then.  In  1959  the 
public  spent  an  estimated  $22  billion,  about 
7  times  as  high  as  in  1929. 

Gross  expenditures  for  medical  care  since 
1929  reflect  a  rise  in  spending  by  consumers 
not  only  for  the  total,  but  also  for  each  major 
component  of  the  medical  care  index  in  both 


August,  1960 


MEDICAL  COSTS  OF  THE  AGED— POLMER 


331 


gross  and  per  capita  terms.  Payments  to 
the  physician,  largest  of  the  components,  in 
1929  through  1954  rose  from  $959  million 
in  1929  to  over  $2.5  million  in  1957.  Al- 
though impressive,  this  increase  has  been 
overshadowed  by  other  components.  The 
physician's  share  of  the  medical  care  dollar 
dropped  from  32.6  to  24.5  cents.  In  contrast, 
spending  for  hospitals  rose  from  $403  mil- 
lion in  1929  to  $3,884  million  in  1957.  In 
like  manner,  expenditures  for  hospital  and 
medical  care  insurance  rose  from  $108  mil- 
lion in  1929  to  $1,064  million  in  1957. 

Part  of  the  increase  in  spending  for  med- 
ical care  followed  the  swelling  income  of  the 
American  people.  Disposable  personal  in- 
come —  that  is,  income  after  taxes  —  rose 
from  $683  per  capita  in  1929  to  $1,812  per 
capita  in  1957.  Medical  expenditures  con- 
stituted 3.5  per  cent  of  disposable  personal 
income  in  1929 ;  it  then  rose  to  4.4  per  cent 
in  1932.  By  1957  spending  for  medical  care 
amounted  to  4.9  per  cent  of  the  disposable 
personal  income.  The  American  consumer, 
including  the  aged  person,  has  been  putting 
greater  emphasis  on  medical  care.  Medical 
care  is  now  becoming  an  important  part  of 
the  American  standard  of  living. 

Economists  must  consider  the  over-all  pic- 
ture in  analyzing  a  situation.  Analysis,  how- 
ever, does  not  prevent  the  economist  from 
understanding  that-  while  he  may  speak  of 
billions  of  dollars  or  millions  of  people,  it  is 
still  the  individual  aged  person  and  his  fam- 
ily that  is  most  important.  All  analysis  will 
concern  large  groups.  The  prime  interest  of 
the  research  still  is  the  individual. 

A  large  segment  of  the  older  population 
does  not  receive  active  hospital  or  nursing 
care.  According  to  available  information, 
about  1.8  per  cent  of  all  older  people  are  in 
the  hospital  a  single  day  and  occupy  less 
than  20  per  cent  of  the  total  number  of  pa- 
tient beds  in  short-term  general  hospitals. 
Yet,  the  recent  report  of  the  Commonwealth 
of  Massachusetts  stated :  "Persons  past  65 
years  of  age  have  the  highest  rates  of  chronic 
disease  and  disability  of  any  age  group.  Al- 
most one  in  every  two  aged  persons  has  a 
chronic  disease  or  impairment.  While  they 
make  up  just  8%  of  the  population,  on  any 
given  day,  they  occupy  18r/(  of  our  general 
hospital  beds,  22%  of  our  long-term  hospital 
beds  and  80  to  90  '/<  of  the  beds  in  nursing 
homes.  In  addition,  it  has  been  estimated 
that  16%  of  the  aged  were  suffering  from  a 
form    of    disability    lasting    more    than    six 


months  as  opposed  to  only  3%  of  the  work- 
ing age  adults.  Not  only  is  their  average 
length  of  stay  longer  in  the  hospital,  nursing 
homes  and  other  institutions,  but  aged  use 
the  services  of  a  physician  more  often  than 
do  any  age  groups." 

The  average  cost  of  medical  care  for  those 
65  years  and  over  is  higher  than  for  the  gen- 
eral population.  The  Health  Information 
Foundation  found  in  the  early  1950's  that 
persons  65  years  of  age  and  over  averaged 
$102  per  person  in  expenditures  for  private 
personal  health  services,  or  57  per  cent  more 
than  the  $65  per  person  cost  in  general  pop- 
ulation. 

The  rise  in  the  aged  population  has 
brought  about  many  conferences,  institutes, 
meetings,  and  statements  of  experts.  It  is 
the  purpose  here  to  present  a  background  for 
viewing  the  expenditures  for  medical  and 
hospital  care  of  the  aged  based  on  current 
research. 

Medical  Costs 

Let  us  be  practical  about  this  matter  of 
medical  costs.  For  some,  any  medical  ex- 
penditure will  be  a  problem ;  for  others,  vir- 
tually no  medical  expenditure  will  be  a  prob- 
lem. It  becomes  important  to  remember  that 
we  are  discussing  only  the  purchase  of  the 
best  type  of  medical  care.  This  is  the  type 
of  medical  care  that  will  answer  the  organic 
or  psychological  problem  facing  the  aged. 
Apparently  no  sum  is  too  great  for  most 
people  to  spend  in  order  to  preserve  life. 
Medical  care  is  not  confined  to  stays  in  the 
hospital  or  visits  to  the  physician.  For  the 
aged-  medical  care  consists  also  of  preventive 
and  rehabilitative  processes  needed  to  main- 
tain the  aged  person  in  active  life  in  the 
community.  Although  preventive  medicine 
is  of  growing  importance,  the  emphasis  here 
will  be  on  the  hospital  and  physician  charges. 
This  is  because  of  lack  of  research  on  the 
actual  payments  for  the  rehabilitative  ele- 
ments of  medical  care.  These  elements,  how- 
ever, are  primordial  in  maintaining  the  aged 
person  in  the  community  and  lowering  fu- 
ture medical  costs. 

The  present  health  conditions  of  the  na- 
tion are  improving.  Besides  medical  ad- 
vances, changes  in  housing,  nutrition,  edu- 
cation, and  employment  for  the  American 
people  in  the  last  half  century  cannot  be 
overlooked.  Although  preventive  medicine, 
rehabilitation,  and  recreation  are  important, 
they  will  not  be  emphasized — in  order  that 


332 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,  19(10 


we   can   concentrate   on   more   controversial 
research. 

"Disease"  and  "Disability" 
We  have  the  unhappy  habit  of  using  the 
words  "illness,"  "disease,"  and  "disability" 
as  if  they  were  interchangable.  The  ma- 
jority of  us  have  some  type  of  disease.  Some 
have  bad  eyes  and  wear  glasses ;  others  have 
sinus  conditions  or  asthma ;  others  have  va- 
rying degrees  of  arthritis.  All  these  are 
diseases.  Each  may  be  important  to  the  in- 
dividual, but  the  key  point  is  the  extent  of 
disability  resulting.  Too  quickly  it  is  pointed 
out  that  the  morbidity  of  the  aged  is  four 
times  that  of  persons  aged  one  to  14.  The 
key  question  still  is:  Does  the  disease  cause 
the  individual  disability  and  higher  medical 
costs?  If  the  individual  has  adjusted  him- 
self to  the  disability,  as  have  those  of  us 
who  wear  glasses,  does  the  condition  really 
matter?  A  chronic  disease  does  not  neces- 
sarily constitute  a  chronic   illness  problem. 

Large  Bills  for  Medical  Care 
Hardly  anyone  likes  to  pay  a  doctor's  or 
hospital  bill ;  the  majority  of  us  never  do 
pay  a  high  bill.  In  a  recent  survey  made  by 
the  magazine  Medical  Economics  to  deter- 
mine the  highest  bills  charged  by  physicians, 
the  median  highest  charge  for  171  special- 
ists was  $650.  Most  bills  for  medical  care 
in  any  one  year  are  less  than  $300.  The 
majority  of  the  people  do  have  more  than 
$300.  A  recent  survey  by  the  New  Jersey 
Blue  Cross  shows  what  this  would  mean. 
The  New  Jersey  Blue  Cross  has  a  120-day 
basic  hospital  care  plan.  Their  study  indi- 
cated that  out  of  every  100  claims  filed  under 
this  plan,  90  were  paid  in  full  by  the  plan. 
Six  were  paid  partially  by  the  plan  and  only 
four  went  into  the  area  of  extended,  high- 
cost  medical  care.  Therefore,  probably  less 
than  10  per  cent  of  those  receiving  hospital 
care  have  high  medical  bills.  The  National 
Health  Service  has  shown  that  approximate- 
ly 90  per  cent  of  the  aged  who  enter  a  short- 
term  general  hospital  are  discharged  in  less 
than  30  days.  These  persons,  however,  fear 
that  they  will  be  one  of  those  10  who  remain 
more  than  30  days.  They  fear  that  they  will 
be  among  those  4  whose  bills  will  extend  be- 
yond the  120  days  of  the  basic  Blue  Cross 
policy.  This  is  a  situation  which  we  must 
come  to  grips  with. 

Does  anyone  really  want  to  cut  the  high 
expenditures  for  medical  care?  Would  the 
aged   person  prefer  to   do  without   medical 


and  hospital  care  rather  than  pay  for  these 
services?  Would  the  physician  prefer  to  give 
his  patient  less  than  the  best  possible  med- 
ical management?  Would  the  hospitals  rather 
not  have  the  radioisotope  department  take 
care  of  patients?  I  think  the  answer  is  that 
everyone  wants  the  best  possible  type  of 
medical  care  and  is  willing  to  pay  for  it,  if  he 
can. 

Medical  expenditures  have  been  rising 
since  1945.  We  do  not  have  the  statistics 
for  the  entire  aged  population,  but  we  do 
have  them  for  the  population  as  a  whole. 
We  may  have  paid  too  much  attention  to 
the  relative  increase  in  medical  costs  and  too 
little  to  what  medical  care  would  have  been, 
had  these  expenditures  not  been  made.  At 
the  present  time  the  entire  population  pays 
about  $2,500,000,000  for  physician  services 
as  contrasted  with  about  $1,500,000,000  in 
1949.  When  it  is  considered  that  in  the  same 
period  of  time  the  national  income  rose  from 
$400  billion  to  approximately  $440  billion 
this  does  not  seem  a  very  great  rise.  The 
same  should  be  said  for  hospital  costs.  We 
have  doubled  hospital  expenditures  since 
1949— from  roughly  $2  billion  to  $4  billion. 
This  may  not  be  too  great  a  price  to  pay 
for  an  increase  of  over  150,000  new  hospital 
beds.  A  hospital  bed  must  be  paid  for  wheth- 
er it  is  being  used  or  not.  The  hospital  must 
be  ready  to  take  care  of  the  patient  in  emer- 
gencies, and  it  costs  roughly  70  per  cent  of 
the  cost  of  an  occupied  bed  to  maintain  an 
unoccupied  bed. 

Paying  Medical  Care  Costs 

These  figures  are  averages,  but  are  the 
aged  able  to  pay  for  these  services?  One 
report  stated  that  60  per  cent  of  the  aged 
have  an  annual  income  of  less  than  $1,000. 
The  aged  are  not  isolated.  The  majority  are 
living  either  with  their  spouses  or  with  a 
family.  For  example,  there  is  the  aged  wid- 
ow who  would  normally  move  in  with  the 
daughter's  family,  if  at  all  possible.  This 
widow  has  a  very  small  income,  but  she  prob- 
ably pays  no  rent  and  receives  some  type  of 
income  from  the  daughter's  husband  whether 
he  likes  it  or  not.  In  a  medical  crisis  the 
family  will,  according  to  recent  research, 
come  together  to  aid  the  mother.  The  mat- 
ter of  income  is  not  the  entire  story  of  the 
aged's  resources  to  pay  for  acute  illness. 

By  the  time  the  aged  person  has  left  the 
labor  market  or  entered  widowhood,  there 
has  been  an  accumulation  of  assets  and  in- 


August,  1960 


MEDICAL  COSTS  OF  THE  AGED— POLMER 


333 


come.  The  direct  income  from  labor  market 
activity  may  not  be  too  great-  but  the  in- 
come based  on  assets  may  be  of  great  value 
in  a  "crisis."  As  an  example,  in  1959,  an- 
nuities based  on  past  income  paid  to  those 
over  age  65  came  to  nearly  $450  million  a 
year.  Whether  the  aged  person  will  consider 
this  income  or  annuities  is  a  question  which 
research  can  throw  little  light  on. 

According  to  available  research,  the  ma- 
jority of  aged  persons  pay  their  entire 
charge  to  the  hospital  and  the  physician. 

Voluntary  Health  Insurance 
We  have  been  discussing  this  entire  ques- 
tion of  medical  expenditures  as  if  voluntary 
health  insurance  did  not  exist.  Of  course  it 
exists  and  is  utilized  by  an  increasing  num- 
ber of  aged  persons.  In  1951  it  was  esti- 
mated that  about  1,800,000  persons  aged  65 
and  over,  or  15  per  cent,  were  covered  by 
voluntary  health  insurance.  By  1958,  43  per 
cent  or  6,600,000  aged  persons  were  being 
covered  by  voluntary  health  insurance.  Last 
year  the  expansion  of  Blue  Cross-Blue  Shield 
and  other  health  insurance  plans  have  prob- 
ably increased  this  number  much  more. 

In  the  past,  we  have  stated  that  voluntary 
health  insurance  among  the  aged  increases 
at  a  rate  of  approximately  3  per  cent  a  year. 
If  we  use  this  conservative  figure,  at  least 
47  per  cent  of  the  total  aged  have  voluntary 
health  insurance.  Yet  there  are  many  aged 
persons  who  for  religious  and  other  reasons 
do  not  want  voluntary  health  insurance  or 
who  can  receive  the  same  benefits  without 
paying  for  it.  Research  provides  some  idea 
of  the  categories  involved.  We  do  not  have, 
however,  exact  figures  as  to  the  number  of 
veterans  who  look  upon  the  local  Veterans 
Administration  hospital  as  "their  voluntary 
health  insurance"  benefit.  The  Health  In- 
surance Association  of  America  estimated 
that  in  1957  between  3  to  5  million  persons 
could  be  included  in  the  group  that  does 
want  or  need  voluntary  health  insurance.  If 
you  take  the  mean  of  4  million  persons,  an 
increasing  coverage  has  been  already  pro- 
vided for  the  aged  by  voluntary  health  in- 
surance. 

Voluntary  health  insurance  seems  to  be 
doing  a  good  job  for  the  majority  of  the 
acutely  ill  aged  people  who  have  it.  A  re- 
cent survey  published  by  the  U.  S.  Depart- 
ment of  Health,  Education  and  Welfare 
stated  that  only  14  per  cent  of  the  couples 
and  9  per  cent  of  the  individuals  under  Old 
Age  Survivors  Insurance  received  any  bene- 


fits from  their  voluntary  health  insurance 
to  help  pay  for  medical  care.  This,  of  course, 
is  true.  In  order  to  determine  what  was  be- 
ing spent  for  all  medical  care,  the  OASI 
attempted  to  survey  all  expenditures  for 
medical  care  such  as  osteopathic  services- 
physicians'  services,  faith-healing,  nursing 
home  care,  dentistry,  hospital  care,  ethical 
and  proprietary  drugs.  The  result  was  ex- 
actly what  everybody  expected.  The  major- 
ity of  aged  people  do  not  go  into  the  hos- 
pital and  do  not  receive  any  aid  from  vol- 
untary health  insurance.  It  is  one  thing  to 
say  that  expenditures  for  proprietary  drugs 
is  a  medical  care  cost.  I  do  not  think  that 
anyone  will  argue  with  the  fact  that  for 
many  this  is  true.  Should  voluntary  health 
insurance  pay  for  the  purchases  of  aspirin, 
vitamins  and  antibiotics?  The  decision  may 
well  be  that  they  should.  If  so,  the  cost  of 
voluntary  health  insurance  may  go  much 
higher  than  it  has  in  the  past.  According  to 
the  statistics  of  the  OASI  survey,  approxi- 
mately 20  per  cent  of  the  OASI  couples  used 
the  hospital  within  a  year.  This  would 
mean  that  while  43  per  cent  of  the  aged  had 
voluntary  health  insurance,  it  may  be  that 
close  to  65  per  cent  of  all  of  those  who  were 
hospitalized  received  aid  from  voluntary 
health  insurance. 

The  quality  of  coverage  provided  by  vol- 
untary health  insurance  is  quite  important. 
There  has  been  no  study  at  the  present  time 
that  can  tell  us  the  amount  of  the  total  hos- 
pital and  physician  charge  to  the  aged  paid 
for  by  voluntary  health  insurance.  Part  of 
the  research  problem  has  been  that  for  cer- 
tain diseases  voluntary  health  insurance  does 
not  provide  aid  for  needs  such  as  cosmetic 
surgery  or  psychotherapy.  Yet  research  in 
Michigan  Blue  Cross  on  the  aged  seems  to 
show  that  approximately  90  per  cent  of  all 
hospital  bills  of  the  aged  were  paid  for  by 
voluntary  health  insurance.  Whether  it 
should  be  100  per  cent  is  a  question  which 
I  think  should  take  additional  study. 

Statements  to  the  effect  that  voluntary 
health  insurance  cannot  provide  coverage  for 
the  aged  come  from  persons  who  have  not 
tried  to  provide  it.  As  an  example,  in  1938 
the  Federal  Government  called  a  conference 
on  voluntary  health  insurance.  The  report 
found  that  because  of  the  low  income  of  the 
people  of  the  United  States,  the  voluntary 
health  insurance  movement  must  fail.  "The 
conclusion  is  inescapable  that  considerable 
proportions  of  the  nation's  families  are  too 


.334 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,  1960 


poor  to  afford  the  cost  of  adequate  medical 
care  from  their  own  resources.  In  the  face 
of  needs  which  are  vital  and  urgent  for,  at 
least,  100  million  persons  in  the  United 
States,  the  Technical  Committee  on  Medical 
Care  cannot  find  the  answer  to  the  nation's 
problem  in  voluntary  insurance  methods." 

"Fortunately,  the  voluntary  health  insur- 
ance movement  went  ahead  and  provided 
coverage.  They  did  not  stop  to  listen  to  the 
experts  who  told  them  it  could  not  be  done. 
By  now  we  have  coverage  for  approximately 
71  per  cent  of  the  entire  population.  It  is 
estimated  that-  possibly  by  1975,  a  large  ma- 
jority of  the  aged  who  need  and  want  vol- 
untary health  insurance  will  have  it.  By 
1958,  for  example,  the  number  of  Blue  Shield 
plans  that  will  enroll  persons  over  age  65 
had  risen  from  8  to  more  than  30  plans, 
with  many  more  planning  to  provide  such 
coverage  within  this  coming  year. 

Catastrophic  Illness 

The  problem,  however,  facing  many  of  the 
aged  is  not  only  one  of  actual  medical  ex- 
penditure. It  is  the  fear  of  a  high  medical 
expenditure  in  the  future.  Almost  everyone 
knows  someone  who  has  had  to  pay  $1,000 
or  $2,000  for  medical  care.  In  essence,  we 
are  discussing  the  chronically  ill  of  any  age. 
It  is  expensive  to  be  ill.  Chronic  illness 
drains  the  resources  of  the  individual  and 
the  family  in  time.  The  85  year  old  person 
with  chronic  arthritis  and  the  Mongoloid 
child  are  both  chronically  ill.  Their  needs 
must  be  provided  for.  Research  seems  to 
suggest  a  way  by  which  this  can  be  done. 
It  has  been  only  10  years  since  the  concept 
of  "major  medical"  or  prolonged  illness  con- 
tract appeared  on  the  American  scene.  Ten 
years  ago  anyone  who  said  that  there  could 
be  a  major  medical  plan  for  over  $5,000  was 
laughed  at.  Today  they  are  selling  major 
medical  plans  for  $10  to  $20,000.  In  Massa- 
chusetts, the  Massachusetts  Blue  Cross-Blue 
Shield  has  an  experimental  program  to  find 
out  about  what  it  would  take  to  sell  a  $5,000 
"Master  Medical"  or  "Prolonged  Illness" 
program  to  the  aged.  One  firm  is  already 
providing  $15,000  worth  of  major  medical 
benefits  to  their  retirees.  With  the  inflation- 
ary trend,  $5  to  $15,000  may  be  too  small  in 
the  future.  Perhaps  it  may  be  necessary  to 
go  to  $40  or  $50,000  in  order  to  make  sure 
that  the  chronically  ill  costs  of  that  small 


group  of  the  aged  are  adequately  taken  care 
of.  If  a  reasonable  deductible  clause  and  a 
reasonable  coinsurance  feature  are  included, 
it  may  be  possible  to  sell  these  policies.  At 
the  same  time,  the  basic  contract  coverage 
must  be  extended. 

Summary 

In  facing  the  problem  of  those  in  the  older 
age  groups  who  are  in  need  of  medical,  eco- 
nomic or  social  aid,  one  can  enumerate  as- 
pects of  that  problem,  devise  solutions,  and 
eventually  try  to  coordinate  the  different 
solutions  into  a  program.  One  can  also  take 
one  of  the  numerous  solutions  in  the  litera- 
ture and  accept  it  as  the  answer.  I  prefer 
the  former  pragmatic  approach.  There  are 
certain  problems  of  medical  care  expendi- 
tures among  the  aged.  They  must  be  met. 
There  is  not  one  single  problem,  but  a  whole 
series.  Perhaps  the  solutions  presented  by 
an  English  doctor  is  one  for  us  to  contem- 
plate. "A  completely  unified  and  regimented 
service  on  the  behalf  of  the  aged  would  be 
akin  to  the  nature  of  the  problem  but  would 
defeat  any  attempt  to  distribute  responsi- 
bility for  them  among  all  classes  of  the  com- 
munity and  might  lessen  public  concern. 
Certainly,  it  may  be  unwise  to  allow  the  idea 
to  gain  substance  that  care  of  the  aged  will 
be  taken  over  completely  by  the  diffuse  father 
figure  of  the  state."  We  are  all  involved,  for 
health  like  happiness  is  an  objective  always 
to  be  sought  even  if  it  can  never  be  fully 
obtained. 

In  the  recent  book,  The  Image  of  America, 
R.  L.  Bruckberger,  a  French  Dominican 
Father,  pointed  out  that  our  country  has 
demonstrated  a  genius  for  solving  social 
problems  that  have  baffled  mankind  for  gen- 
erations. There  is  very  little  marriage  to 
dogma  and  ideology,  but  a  great  national 
confidence  that  we  can  find  solutions  to  our 
difficulties.  This  has  resulted  in  the  willing- 
ness to  experiment,  to  explore,  to  be  flexible 
in  our  approach  to  social  and  economic  prob- 
lems and  developments.  The  question  of 
paying  for  medical  care  by  the  aged  will  be 
met  in  the  same  way. 


(Note:  An  extensive  bibliography  has  been  prepared  for  this 
article.    It  may  be  obtained  from   the   editor). 


August,  1960 


ADVERTISEMENTS 


XXV 


One  way  or  another  people  will  seek 
out  new  ways  to  cope  with  old  prob- 
lems. Yet  progress  must  be  wisely 
guided.  One  doctor  says: 'The  desire 
of  the  public  to  have  prepayment 
medical  protection  is  so  urgent 
that  it  will  buy  this  protection  from 
whatever  plan  seems  most  enticing. 
Whether  you  like  it  or  not,  prepay- 
ment medical  care  is  here  to  stay.  Let 
us  support  the  system  which  is  vol- 
untary and  over  which  we  have  ade- 
quate control."  BLUE  SHIELD 


HOSPITAL  SAVING  ASSOCIATION 

CHAPEL  HILL,  NORTH  CAROLINA 


mKmm 


pharmacologically  ancTclinically  the   outstanding 


Rapid  peak  attainment  —  for  early  control  — 

KYNEX&  Sulfamethoxypyridazine  reaches  peak 
plasma  levels  in  1  to  2  hours'  2  ...  or  approximately 
one-half  the  time  of  other  once-a-day  sulfas.2  Unin- 
terrupted control  is  then  sustained  over  24  hours  with 
the  single  daily  dose  .  .  .  through  slow  excretion  with- 
out renal  alteration. 

High  free  levels  —  for  dependable  control  — 

More  efficient  absorption  delivers  a  higher  percentage 
of  sulfamethoxypyridazine  —  averaging  20  per  cent 
greater  at  respective  peaks  than  glucuronide-conver- 
sion  sulfas."  Of  the  total  circulating  levels.  95  per  cent 
remains  in  the  fully  active,  unconjugated  form  even 
after  24  hours.3 


Extremely  low  toxicity1  .  .  .  only  2.7  per  cent 
incidence  in  recommended  dosage  —  Typical  of 
KYNEX  relative  safety,  toxicity  studies"'  in  223 
patients  showed  TOTAL  side  effects  (both  subjective 
and  objective )  in  only  six  cases,  all  temporary  and 
rapidly  reversed.  Another  evaluation1  in  110  patients 
confirmed  the  near-absence  of  reactions  when  given 
at  the  recommended  dosage.  High  solubility  of  both 
free  and  conjugated  product0  obviates  renal  compli- 
cations. No  crystalluria  has  been  reported. 

Successful  against  these  organisms:  strepto- 
cocci, staphylococci,  E.  coli,  A.  aerogenes,  paracolon' 
bacillus,  Gram-negative  rods,  pneumococci,  diphthe- 
roids, Gram-positive  cocci  and  others 


1.  Boger,  W.  P.;  Strickland,  C.  S.,  and  Gylfe,  J.  M.i  Antibiotic  Med,  _&  Clin.  Thpr,  3:378.  (Nov.)  1956.  2.  Boger,  W.  P.:  Antibiotics  Annua 
1958-1959,  New  York,  Medical  Encyclopedia.  Inc.,  1959,  p.  48.  3.  Sheth,  U.  K.;  Kulkarni,  B.  S..  and  Kamath,  P.  G.:  Antibiotic  Med.  &  Clin 
Ther.  5:604  (Oct.)  1958.  4.  Vinnicombe.  J.:  Ibid.  5:474  (July)  1958.  5.  Anderson,  P.  C,  and  Wissinger,  H.  A.:  U.  S.  Armed  Forces  M.  J_.  10:1051 
(Sept.)   1959.  6.  Roepke,  R.  R.;  Maren,  T.  H.,  and  Mayer,  E.:  Ann.   New  York  Acad.  Sc.  60:457  (Oct.)  1957. 


KYNEX 


( 


) 


is  your 
drug  of 
choice 


i 


once-a-day  sulfa. 


NOTE:  Investigators  note  a  tendency  of  some  patients  to 
misinterpret  dosage  instructions  and  take  KYNEX  on  the 
familiar  q.i.d.  schedule.  Since  one  KYNEX  tablet  is  equiva- 
lent to  eight  to  twelve  tablets  of  other  sulfas,  even  mod- 
erate overdosage  may  produce  side  effects.  Thus,  the 
single  dose  schedule  must  be  stressed  to  the  patient. 

KYNEX  Tablets,  0.5  Gm.,  bottles  of  24  and  100.  Dosage: 
Adults,  0.5  Gm.  (1  tablet)  daily,  following  an  initial  first 
day  dose  of  1  Gm.  (2  tablets). 

KYNEX  Acetyl  Pediatric  Suspension,  cherry-flavored.  250 
mg.  sulfamethoxypyridazine  activity  per  teaspoonful  (5  cc). 
Bottles  of  4  and  16  fl.  oz.  Recommended  Dosage:  Children 
under  80  lbs.:  1  teaspoonful  (250  mg.)  for  each  20  lb.  body 
weight,  the  first  day,  and  Vz  teaspoonful  per  20  lb.  per  day 
thereafter.  For  children  80  lbs.  and  over:  4  teaspoonfuls 
(1.0  Gm.)  initially  and  2  teaspoonfuls  daily  thereafter.  Give 
immediately  after  a  meal. 


KYNEX 

Sulfamethoxypyridazine  Lederle 

NEW-for  acute  G.U.  infection  AZO-KYNEX"  Phenylazodiaminopyridine  HCI  — Sulfa- 
methoxypyridazine Tablets,  contains  125  mg.  KYNEX  in  the  shell  with  150  mg. 
phenylazodiaminopyridine  HC!  in  the  core.  Dosage:  2  tablets  q.i.d.  the  first  day; 
1  tablet  q.i.d.  thereafter. 


LEDERLE     LABORATORIES,     a     Division     of     AMERICAN     CYANAMID     COMPANY,     Pearl     River,    New    York 


Concerning   Your   Health   and   Your   Income 

A  special  report  to  members  of  the  Medical  Society  of 

the  State  of  North  Carolina 

on  the  progress  of  the  Society's 

Special  Group  Accident  and  Health  Plan 

in  effect  since  1940 

PROUDLY  WE  REPORT     1959 

AS  OUR  MOST  SUCCESSFUL  YEAR  IN  SERVING  YOUR  SOCIETY. 

During  the  year  we  introduced  a  NEW  and  challenging  form  of  disability  protec- 
tion.  There  has  been  overwhelming   response   on  the  part  of  the  membership. 

Participation    in   this  Group  Plan   continues  to  grow  at  a  fantastic  rate. 

1960 

is  our  20th  year  of  service  to  the  Society.    It  is  our  aim  to  continue  to  lead  the  field  in  pro- 
viding  Society  members  with  disability  protection  and  claim   services  as  modern  as  tomor- 
row. 

SPECIAL    FEATURES    ARE: 

1.  Up  to  a  possible  7  years  for  each  sickness  (no  confinement  required). 

2.  Pays  up  to  Lifetime  for  accident. 

3.  New  Maximum   limit  of  $650.00  per  month  income  while  disabled. 

All  new  applicants,  and  those  now  insured,  who  are  under  age  55,  and  in  good 
health,  are  eligible  to  apply  for  the  new  and  extensive  protection  against  sickness  and  ac- 
cident. 

OPTIONAL    HOSPITAL   COVERAGE:      Members  under  age  60  in  good  health  may  apply  for 
$20.00  daily  hospital   benefit  —  Premium  $20.00  semi-annually. 

Write,   or  call   us  collect  (Durham   2-5497)  for  assistance  or  information. 

BENEFITS  AND  RATES  AVAILABLE   UNDER   NEW  PLAN 

COST   UNTIL  AGE   35        COST   FOR   AGES  35   TO  'i 


Accidental    Death  'Dismemberment 


Coverage  Loss    of    Sight,    Speech  Accident    and  Annual  Semi-Annual  Annual  Semi-Annual 

or    Hearing  Sickness    Benefits  Premium  Premium  Premium  Premium 

5,000  5,000  to  10,000  50.00  Weekly  $   78.00  $   39.50  $104.00  $   52.50 

5,000  7,500  to  15,000  75.00  Weekly  114.00  57.50  152.00  76.50 

5,000  10,000  to  20,000  100.00  Weekly  150.00  75.50  200.00  100.50 

5,000  12,500  to  25,000  125.00  Weekly  186.00  93.50  248.00  124.50 

5,000  15,000  to  30,000  150.00  Weekly  222.00  111.50  296.00  148.50 

'Amount  payable   depends    upon   the    nature  of  the  loss  as  set  forth   in  the  policy. 

Administered   by 
J.    L.   CRUMPTON,   State   Mgr. 
Professional   Group    Disability    Division 
Box    147,   Durham,   N.   C. 

J.  Slade  Crumpton,   Field   Representative 
UNDERWRITTEN    BY   THE  COMMERCIAL   INSURANCE  COMPANY  OF  NEWARK,  N.  J. 

Originator    and    pioneer    in    professional    group    disability    plans. 


August,  1960 


335 


Medical  Problems  Facing  Congress 


Sam  J.  Ervin,  Jr.* 
Washington,  D.  C. 


It  is  a  great  privilege  to  be  here  today 
and  to  talk  to  you  who  practice  the  healing 
art.  Any  member  of  a  legislative  body  is 
necessarily  concerned  with  public  health, 
because  the  government  has  been  concerned 
with  this  problem  for  generations. 

We  have  many  problems  in  Washington, 
but  I'm  inclined  to  think  that  some  of  the 
solutions  offered  are  worse  than  the  prob- 
lems. We  have  a  very  loquacious  member 
of  the  Senate  in  the  person  of  Hubert 
Humphrey.  Some  newspaper  man  writing 
about  him  a  few  days  ago  said  he  was  the 
only  man  in  public  life  who  had  had  more 
solutions  than  there  were  problems.  Inci- 
dentally, I  think  maybe  the  medical  pro- 
fession has  a  few  unsolved  problems  of  its 
own. 

The  Government's  Role  in  the 
Field  of  Health 

I  want  to  talk  this  morning,  as  briefly 
as  any  member  of  the  United  States  Sen- 
ate can  talk,  about  the  place  of  the  federal 
government  in  the  field  of  health.  I  think 
the  federal  government  has  a  real  place  in 
this  field,  and  one  that  has  probably  become 
more  important  as  a  result  of  existing  con- 
ditions. 

The  most  astounding  advances  have  been 
made  in  medicine  during  the  past  quarter 
century  than  in  any  other  field  of  life.  In 
the  old  days  a  doctor  could  carry  the  tools 
of  his  profession  in  a  small  bag,  but  with 
the  advancement  of  medical  science,  the 
cost  of  treatment,  when  considered  on  a 
nationwide  basis,  has  become  enormous. 

In  the  days  before  the  astronomical  rise 
of  the  national  budget,  when  Congress 
thought  that  perhaps  the  taxpayers  knew 
better  how  to  spend  their  income  than  Con- 
gress did,  and  when  income  taxes  were 
either  nonexistent  or  low,  many  people 
were  able  to  make  great  contributions  to 
causes  and  institutions  such  as  hospitals 
and  medical  schools.  But  as  time  passed 
and  the  national  budget  rose  from  $3  bil- 
lion in   1930   to   $79.8   billion   in   1960,   the 

Reporter's     Transcript    of     an     address     delivered     before     the 
First    General    Session    of    the    Medical    Society    of    the    State    of 
North    Carolina,    Raleiffh.    May    9,    1060. 
"Senior  Senator  from  North  Carolina. 


federal  government  has  been  confiscating 
large  parts  of  the  individual  personal  in- 
come of  the  American  people  by  way  of  the 
federal  income  tax.  As  a  result,  it  has  be- 
come virtually  impossible  for  people  to 
amass  large  fortunes  as  they  did  in  times 
gone  by,  and  consequently  individual  gifts 
to  medical  school  and  hospitals  have  great- 
ly diminished.  This  factor  has  added  to  the 
difficulties  confronting  the  nation  at  this 
time. 

From  the  time  that  the  Marine  Hospital 
was  established  in  1797  down  to  this  day, 
the  federal  government  has  had  a  real 
place  in  the  field  of  public  health.  Today, 
as  you  know,  it  makes  grants  to  state  and 
local  health  authorities  for  general  pur- 
poses and  sometimes  for  specific  ones. 

Then  the  federal  government  I  think,  has 
a  right,  under  the  Hill-Burton  Act,  to  as- 
sist the  states  and  communities  in  the  erec- 
tion of  hospitals.  This  program  has  been 
extended  of  late  to  include  nursing  homes. 

The  federal  government,  I  believe,  has  a 
real  place  in  the  field  of  medical  research 
and  is  doing  a  fine  job  in  the  National  In- 
stitutes of  Health  in  Bethesda,  Maryland. 

As  a  result  of  the  inability  of  the  Amer- 
ican people  to  make  large  gifts  to  medical 
schools,  the  federal  government  can  help 
(1)  through  cooperative  arrangements  with 
the  faculties  of  medical  schools  in  the  re- 
search field,  and  (2)  by  providing  fellow- 
ships and  traineeships  to  medical  students. 
Also,  I  think  the  government  has  done  a 
fine  thing  in  establishing  the  great  insti- 
tution which  we  now  have  in  Cincinnati 
for  study  in  that  very  essential  field  of 
public  health. 

Objections  to  Pending  Bills 

I  know  you  are  interested  in  some  of  the 
medical  problems  now  confronting  Con- 
gress, and  particularly  in  the  Forand  bill. 
A  number  of  other  proposals  are  pending. 

If  I  controlled  the  situation,  I  would 
postpone  any  consideration  of  these  bills 
until  next  January,  simply  because  most  of 
them,  when  analyzed,  appear  to  be  designed 
to  promote  or  protect  the  political  health 
of  some  members  of  Congress,  rather  than 


336 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,  1960 


the  health  of  the  people  in  whose  behalf 
they  are  supposed  to  be  offered. 

Frankly,  I  believe  that  a  serious  problem 
exists  in  this  field — one  which  merits  the 
consideration  of  the  medical  profession,  the 
Congress,  the  states,  and  local  communi- 
ties. But  I  do  not  think  that  any  of  the  pro- 
posals made  thus  far  are  the  correct  solu- 
tions. 

With  no  wish  to  be  partisan,  I  refer  first 
to  the  Administration  Program — a  hodge- 
podge proposal,  thrown  together  hurriedly 
merely  as  what  you  would  call  a  counter- 
irritant  to  the  other  political  bills  on  this 
subject. 

Contrary  to  Social  Security  concept 

These  proposals  have  several  fundamen- 
tal objections.  In  the  first  place,  being 
geared  to  Social  Security  rules,  they  in- 
volve a  serious  question  as  to  whether  or 
not  we  should  depart  from  the  original 
concept  which  underlies  the  system. 

This  idea  was  that,  while  the  system  was 
compulsory  in  nature,  when  a  person  be- 
came eligible  for  Social  Security  benefits 
he  was  to  receive  them  as  a  free  man ;  that 
they  belonged  to  him,  and  that  he  was  to 
have  the  privilege  of  doing  what  he  wished 
with  them. 

A  bill  which  undertakes  to  place  the  cost 
of  medical  and  hospital  care  under  the  So- 
cial Security  system  is  an  absolute  depar- 
ture from  that  concept,  because  it  provides 
that  the  contracts  are  to  be  made  by  the 
Secretary  of  the  Department  of  Health, 
Education  and  Welfare,  except  when  he 
might  delegate  that  authority  to  some  one 
of  the  insurance  companies.  Furthermore, 
he  not  only  makes  these  contracts  but  han- 
dles the  monies  for  all  recipients  of  Social 
Security  benefits.  So  one  serious  problem 
confronting  the  American  people  and  the 
Congress  is  whether  or  not  they  are  going 
to  depart  entirely  from  the  original  Social 
Security  concept  that  a  man  should  be  free 
to  handle  his  own  funds. 

These  bills  say,  of  course,  that  a  man  can 
select  his  own  surgeon  and  his  own  hos- 
pital. This  is  not  exactly  true,  because  he 
can  select  only  a  surgeon  or  a  hospital  hav- 
ing a  contract  with  the  Secretary  of  Health, 
Education  and  Welfare,  or  with  the  dele- 
gated agent  of  the  Secretary.  Furthermore, 
he  is  denied  the  right  to  make  any  con- 
tract with  respect  to  his  treatment,  because 


he  cannot  contract  to  pay  the  hospital  or 
the  surgeon  a  cent  more  money  than  that 
which  is  to  be  paid  by  the  government  un- 
der the  contract  with  the  Secretary  or  his 
agents. 

Fail  to  help  the  neediest 

One  objection,  as  I  see  it,  to  these  bills 
in  their  present  form  is  that,  except  the 
Administration  bill  and  the  McNamara  bill, 
none  of  them  provides  any  assistance  what- 
ever for  the  people  who  need  it  the  most. 
As  a  general  rule  most  of  the  people  on 
Social  Security  can  meet  their  own  medical 
expenses. 

At  the  risk  of  being  charged  with  the 
same  offense  as  was  a  storekeeper  that  I 
will  now  tell  you  about,  I  want  to  present  a 
few  statistics.  A  certain  mountaineer  who 
had  been  buying  groceries  on  credit  at  the 
neighborhood  store  received  a  bill  which 
was  considerably  more  than  he  thought  it 
ought  to  be.  When  he  complained,  the  gro- 
cer got  out  the  account  book,  laid  it  on  the 
counter,  and  said:  "Here  are  the  figures; 
look  at  them  yourself.  Figures  don't  lie." 

The  mountaineer  said,  "No,  figures  don't 
lie,  but  liars  sure  do  figure." 

At  the  risk  of  falling  into  that  category, 
I  wish  to  quote  some  figures  that  I  think 
are  germane  to  this  matter.  There  are  ap- 
proximately 16  million  people  in  the  United 
States  of  the  age  of  64  and  up,  who  are 
now  called  aged  people  in  legislative  par- 
lance in  Washington.  Of  these  approxi- 
mately 2,250,000  receive  Old  Age  Assist- 
ance. They  are,  in  a  sense,  financially  desti- 
tute. They  are  the  people  who  normally 
need  medical,  surgical  or  hospital  treat- 
ment the  worst,  but  are  the  least  able  to 
provide  it  for  themselves. 

Such  measures  as  the  Forand  bill  make 
no  provision  whatever  for  this  group  of 
people.  Benefits  are  confined  to  those  who 
are  receiving  Social  Security,  and  the  aver- 
age person  on  Social  Security,  even  though 
he  be  65  or  older,  can  pay  his  own  medical 
and  hospital  bills.  The  records  show  that 
these  bills  average  approximately  $125  in 
the  course  of  a  year,  and  most  Social  Se- 
curity beneficiaries  can  handle  that. 

Now,  the  people  who  receive  Old  Age 
Assistance  do  so  because  they  are  destitute. 
If  there  is  any  group  of  people  that  are  in 
need,  not  only  of  the  necessities  of  life  but 
also  medical  care,  it  is  they.  It  is  true  they 
receive   some   medical   benefits   through  the 


August,  I960 


MEDICAL  PROBLEMS  FACING  CONGRESS— ERVIN 


337 


Welfare  Service,  and  I  think  that  those 
benefits  should  be  expanded. 

Another  group  of  persons  that  I  think 
the  medical  profession,  the  Congress,  and 
the  state  legislatures  and  state  health 
authorities  must  consider  are  elderly  peo- 
ple who  have  just  enough  property  to  be 
ineligible  for  Old  Age  Assistance  but  who 
would  be  destroyed  financially  by  chronic, 
protracted  illnesses. 

The  average  person  under  the  Social  Se- 
curity system  does  not  come  within  this 
group,  which  constitutes  only  a  minority  of 
our  elderly  citizens.  But  there  must  be  some 
system  whereby  discretionary  power  would 
be  given  the  public  health  authorities  to  as- 
sist these  persons,  and  there  should  be  pro- 
vision through  the  Welfare  Service  to  help 
those  in  a  more  expanded  way  on  Old  Age 
Assistance. 

Fundamentally,  the  trouble  with  the  cur- 
rent proposals  is  that  they  do  not  help  the 
people  who  are  most  in  need  of  aid.  Politi- 
cians are  funny  when  they  start  doing 
something:  they  want  to  be  like  the  rain 
which  falls  on  the  just  and  the  unjust  alike. 
In  this  case,  they  want  the  benefits  to  fall 
on  the  needy  and  those  that  are  not  needy. 
They  treat  them  exactly  the  same.  That  is 
precisely  what  these  bills  do. 

For  that  reason,  since  they  exclude  peo- 
ple on  Old  Age  Assistance  and  make  no 
provision  for  those  with  limited  means  who 
suffer  for  long-  periods  of  time,  are  chron- 
ically ill,  and  ought  to  have  some  discre- 
tionary relief  rather  than  relief  which  ap- 
plies to  all  alike,  I  am  opposed  to  such  leg- 
islation. 

Limited  benefits 

The  bills  are  inadequate  for  another  rea- 
son. They  are  limited.  Under  these  bills — 
the  Forand  bill,  for  example — a  man  can 
get  two  months  of  hospital  treatment.  That 
wouldn't  help  anyone  who  was  sick  for 
months  and  months  or  a  person  who  is 
chronically  ill  for  several  years.  It  is  true 
he  can  go  to  the  hospital  for  two  months, 
but  then  he  would  have  to  get  along  as  best 
he  could,  and  it  would  be  10  more  months 
before  he  would  be  eligible  to  go  back  to 
the  hospital.  Furthermore,  provision  is 
made  for  surgical  but  not  medical  treat- 
ment. The  tragedy  is  that  every  day  I  re- 
ceive letters  from  old  people  urging  that 
certain  bills  be  passed,  when  most  of  the 
writers    wouldn't    receive    a    single    penny 


under  any  of  them,  with  the  possible  ex- 
ception of  some  phases  of  the  Administra- 
tion bill,  which,  as  I  say,  is  a  hodge-podge 
hurriedly  thrown  together  as  a  counter- 
irritant  for  the  other  bills.  It  is  a  tragedy 
that  the  old  people  of  this  country  have 
been  deceived  about  the  contents  of  these 
bills.  They  think  all  their  medical  expen- 
ses, all  their  hospital  expenses,  and  all  their 
surgical  expenses  would  be  covered,  where- 
as the  neediest  people  wouldn't  receive  any 
benefits  whatsoever. 

Threat  to  doctor-patient  relations 

To  me  one  of  the  greatest  relationships 
that  exists  is  that  of  patient  and  physician. 
These  bills  would  certainly  interfere  with 
that  relationship  because,  while  they  pro- 
fess that  the  man  is  free  to  select  his  sur- 
geons or  free  to  select  his  hospital,  he  has 
to  select  a  hospital  or  a  surgeon  who  is 
under  contract  with  the  Secretary  of 
Health,  Education  and  Welfare  or  his 
agent.  Furthermore,  he  cannot  contract, 
however  much  he  may  need  it,  if  he  goes 
into  a  hospital  under  one  of  these  bills, 
above  the  contracted  for  price  of  the  hos- 
pital. Under  the  contract  with  the  Secre- 
tary, he  cannot  make  any  contract  to  pay 
any  more,  even  though  he  may  need  more 
than  he  is  allowed. 

One  thing  is  certain :  when  the  federal 
government  begins  to  pay  medical  bills  di- 
rectly, the  next  step  is  standardization,  and 
you  are  going  to  have  standardization  un- 
der the  auspices  of  the  federal  government 
if  one  of  these  bills  is  passed.  The  Secre- 
tary of  Health,  Education  and  Welfare  is 
to  write  regulations  to  carry  out  the  pro- 
visions, and  I  doubt  whether  any  of  you 
physicians,  except  those  engaged  in  public 
health  work,  really  understand  what  this 
means. 

The  last  time  I  was  engaged  in  the  active 
practice  of  law,  I  subscribed  to  the  publi- 
cation known  as  the  Federal  Register, 
which  contains  all  tederal  regulations.  As 
the  issues  came  out,  I  had  them  bound  and 
placed  in  my  office  for  a  period  of  18 
months.  The  regulations  and  changes  in 
regulations  for  only  18  months  occupied  a 
space  of  about  28  inches,  by  actual  meas- 
urement. 

You  are  going  to  have  these  regulations, 
and  you  are  going  to  have  things  stand- 
ardized, and  you  are  going  to  destroy  one 
of  the  greatest  human  relationships  known 


338 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,  19G0 


to  man,  the  relationship  of  physician  and 
patient;  and  for  that  reason  I  look  upon 
these  bills  with  grave  misgivings. 

To  repeat,  I  do  think  there  is  a  problem 
here,  but  it  lies  in  the  case  of  persons  on 
Old  Age  Assistance  and  those  who  have 
just  enough  to  be  excluded  from  that  un- 
fortunate group,  but  not  enough  to  bear  the 
cost  of  a  loii  •  illness.  That  is  a  problem 
that  the  medic?.]  profession,  the  Congress, 
the  state  legislatures,  and  public  health 
authorities  must  be  concerned  with.  A  solu- 
tion must  be  found,  but  I  do  not  think  that 
it  lies  in  the  adoption  of  a  system  under 
which  the  federal  government  assumes  the 
responsibility  for  the  medical  needs  of 
virtually  all  of  our  elderly  citizens.  The  peo- 
ple who  should  be  helped  are  those  who 
need  help,  and  the  rest  should  be  allowed 
to  act  as  free  men  and  free  women,  as  the 
Social  Security  system  in  its  original  con- 
cept contemplated. 

I  return  to  what  I  said  at  the  beginning 
of  this  talk:  that  the  kindest  thing  that 
can  be  done  with  this  serious  problem  of 
the  chronically  ill  is  to  postpone  further 
discussion  until  the  atmosphere  is  free 
from  the  political  bargaining  which  is  now 
going  on  in  Washington  in  reference  to  the 
Presidential  election  of  1960. 

Voluntary  Health  Insurance 
In  my  opinion,  the  problem  of  the  chron- 
ically ill  cannot  be  met  entirely  by  the  vol- 
untary insurance  program.  That  is  a  mar- 
velous program,  however,  and  I  want  to  call 
your  attention  to  the  astounding  increase 
in  the  number  of  persons  protected  by 
it.  The  figures  for  1957  indicate  that 
121  million  people  in  the  United  States,  or 
72  per  cent  of  the  total  population,  had 
hospitalization  insurance  of  some  kind,  as 
contrasted  with  37  per  cent  who  had  hos- 
pital insurance  10  years  before. 

In  1957,  109  million  persons  in  the  United 
States  (55  per  cent  of  the  total  population) 
had  voluntai-y  insurance  policies  which  took 
care  of  the  hospital  and   surgical  costs   to 


some  extent.  In  1957,  57  per  cent  had 
health  policies  which  provided  for  the  pay- 
ment of  medical  treatment,  as  distin- 
guished from  surgical  treatment,  in  addi- 
tion to  hospitalization.  In  view  of  these 
figures,  we  should  refrain  from  adopting 
any  system  which  would  tend  to  destroy 
the  willingness  of  the  American  people  to 
procure  hospital,  surgical,  and  medical  in- 
surance on  their  own  volition. 

The  amounts  paid  under  these  plans  is 
astounding.  Also  in  1957,  57  per  cent  of  all 
the  cost  of  hospital  services  in  the  United 
States  and  31  per  cent  of  all  bills  for  sur- 
gical and  medical  expenses  was  paid  by 
these  voluntary  plans.  I  hope  that  the 
services  rendered  by  such  organizations  as 
Blue  Cross  and  Blue  Shield,  which  are  do- 
ing a  fine  job  in  North  Carolina,  continue 
to  expand,  and  that  they  will  be  even  more 
widely  accepted. 

Some  of  the  companies  today  are  at- 
tempting to  devise  policies  that  cover  the 
needs  of  the  aged.  One  of  the  main  argu- 
ments used  for  the  Forand  bill  is  the  great 
spread  of  difference  between  the  nonprofit 
organizations,  which  return  about  97  per 
cent  of  their  premiums  in  services  to  their 
policyholders,  and  the  private  insurance 
companies,  which  do  not  do  anywhere  near 
that  well. 

Conclusion 

I  believe  in  the  expansion  of  nonprofit 
organizations.  But  when  voluntary  insur- 
ance is  improved  and  extended,  the  prob- 
lem that  will  still  confront  the  medical  pro- 
fession, Congress,  and  the  states  is  that  of 
people  receiving  Old  Age  Assistance,  and 
of  those  suffering  long  illnesses  who  are 
barely  ineligible  for  Old  Age  Assistance. 
That  is  the  problem  that  should  concern 
you  as  well  as  the  Congress  and  the  state 
legislature. 

Whatever  we  do,  we  must  see  to  it  that 
the  personal  relationship  of  physician  and 
patient  is  preserved. 


The  doctor's  wife  is  truly  the  unsung  hero  of  Medicine,  because  the 
extra  hours  of  faithful  service  to  patients  and  the  hours  spent  attending 
medical  meetings  and  studying  the  medical  literature  must  be  subtracted 
from  the  time  the  doctor  would  otherwise  spend  with  his  family.  It  has 
been  said  that  the  wife  has  the  doctor  when  no  one  else  wants  him. — 
Rouse,  M.O.,  South.  M.J.  53:1  (Jan)   1960. 


August,  1960 


339 


Leptospirosis 

Report  of  a  Case 

William  A.  Leonard,  Jr.,  M.D. 

Greensboro 


For  the  past  decade  veterinarians  have 
called  attention  to  the  occurrence  of  disease 
due  to  Leptospira  in  animal  life  in  temper- 
ate climates.  The  disease  in  man  has  re- 
ceived some  recent  notice,  but  is  probably 
more  widespread  than  is  generally  known. 
In  North  Carolina  it  received  wide  recog- 
nition in  1942-1944,  when  it  was  deter- 
mined that  so-called  "Fort  Bragg  Fever" 
was  due  to  Lept.  autumnalisa) .  Sporadic 
cases  have  been  reported  since12',  but  the 
following  is  believed  to  be  the  first  case  re- 
ported from  Guilford  County. 

It  has  been  demonstrated  in  this  state 
and  elsewhere  that  a  wide  variety  of  do- 
mestic and  wild  animals  harbor  the  organ- 
ism(3).  The  infection  apparently  presents 
a  chronic  problem  in  animals,  with  the  ex- 
cretion of  Leptospirae  in  the  urine  for  pro- 
longed periods.  Contrary  to  an  earlier  con- 
cept, apparently  any  animal  may  harbor 
any  one  of  a  variety  of  recognized  serotypes 
of  the  organism  which  are  present  in  the 
United  States.  In  other  words,  there  is  no 
apparent  animal  or  syndrome  specificity. 

Weil's  disease,  a  fulminating  form  char- 
acterized by  fever,  jaundice,  renal  damage 
and  hemorrhage,  was  originally  presented 
as  the  classic  form  of  the  disease  in  man. 
In  more  recent  years  it  has  become  obvious 
that  the  more  common  clinical  syndrome  is 
presented  by  a  mild  type  of  infection  not 
unlike  grippe,  influenza,  nonparalytic  polio, 
or  aseptic  meningitis.  Again,  as  in  animals, 
any  one  of  the  leptospiral  serotypes  may 
result  in  a  similar  clinical  picture.  This 
similarity  to  other  common  and  benign  ill- 
nesses has  undoubtedly  been  the  main  de- 
terrent to  its  recognition. 

Case  Report 

A  39  year  old  white  male  carpenter  was 
well  until  two  days  before  admission,  when 
he  noted  the  sudden  and  progressive  de- 
velopment of  profound  fatigue,  followed 
shortly  by  frank  chilling,  generalized  mus- 
cular aching,  a  moderate  generalized  head- 
ache, and  a  fever  of  104  F.  The  past  his- 
tory was  not  contributory. 


Physical  examination  revealed  an  acute- 
ly ill,  toxic  individual  in  obvious  discom- 
fort. The  conjuctivae  were  suffused.  There 
were  fine  crepitant  rales  at  the  base  of  the 
right  lung  posteriorly  and  laterally.  The 
heart  was  not  remarkable  exceot  for  an 
apical  rate  of  120.  The  abdomen  was  slight- 
ly distended  but  non-tender.  The  liver  and 
spleen  were  not  palpable,  and  no  hepatic 
tenderness  was  demonstrated  on  percus- 
sion. The  pharynx  was  minimally  injected. 
No  significant  adenopathy  was  noted.  The 
remainder  of  the  examination  was  entirely 
within  the  limits  of  normal. 

Laboratory  findings:  A  urinalysis  was 
negative.  The  blood  count  showed  8,500 
white  cells,  with  86  polymorphonuclears,  1 
eosinophil,  1  monocyte,  and  12  lympho- 
cytes. A  serologic  test  for  syphilis  was  neg- 
ative. An  electrocardiogram  was  within  the 
limits  of  normal  except  for  a  sinus  tachy- 
cardia. Roentgenograms  of  the  chest  showed 
prominent  pulmonary  markings  at  the 
right  median  base. 

The  initial  clinical  impression  was  that 
of  primary  atypical  pneumonia  of  unknown 
etiology.  Because  of  the  patient's  toxic 
state,  however,  he  was  started  on  thera- 
peutic doses  of  chloramphenicol.  Because  of 
doubt  concerning  the  diagnosis,  blood  was 
drawn  at  the  time  of  admission  for  possible 
agglutination  determinations  later.  A  blood 
culture  was  not  obtained. 

Since  antibiotic  therapy  had  obviously 
brought  about  little  improvement  within  48 
hours,  it  was  discontinued.  (Antibiotics 
have  only  questionable  value  in  leptospiro- 
sis) (4).  At  this  time,  the  fine  crepitant  rales 
were  continuously  noted  at  the  right  base, 
and  a  few  rales  were  present  in  the  left 
base  posteriorly.  The  patient  continued  to 
be  acutely  ill,  and  symptomatic  treatment 
was  used  to  control  the  muscular  aching. 
The  febrile  course  is  noted  on  the  accom- 
panying chart  (fig.  1).  At  this  point,  be- 
cause of  the  continued  presence  of  marked 
conjunctival  suffusion,  the  possibility  of 
leptospirosis  was  considered. 


:to 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,  1960 


105° 

\ 

1 

1 
1 

104 

103 

\ 

b 

102 

ff 

\ 

A 

r 

101 

1 

r 

\/ 

\ 

J 

\ 

100 

V 

V\ 

986 

v\ 

Day    of 

3 

4 

5 

6 

7 

8 

9 

10 

illne  ss 



1 

Fig.   1.  Clinical  course. 

The  fever  and  symptoms  gradually  di- 
minished until  the  sixth  day  of  illness,  when 
the  patient  felt  reasonably  well.  On  this 
evening-  he  was  intermittently  confused  and 
disoriented.  He  awakened  on  the  seventh 
day  with  a  moderately  severe  headache,  and 
nuchal  rigidity  was  observed.  A  lumbar 
puncture  was  done,  with  an  initial  pressure 
of  230  mm.  of  water  and  a  final  pressure 
of  130  after  the  gradual  removal  of  10  cc. 
of  a  hazy  fluid.  The  specimen  contained  300 
cells  per  cubic  millimeter,  predominently 
lymphocytes.  The  protein  was  86  mg.  per 
100  ml.  and  the  sugar  76  mg.  per  100  ml. 
Culture  was  sterile  on  routine  media. 
Fletcher's  media  was  not  available.  The 
onset  of  the  meningitis  on  the  seventh  day 
of  illness  and  the  characteristic  spinal  fluid 
changes'""  appeared  to  confirm  the  clinical 
impression  of  leptospirosis. 

As  will  be  noted  on  the  accompanying 
clinical  chart,  the  patient  had  some  eleva- 
tion of  temperature  following  the  onset  of 
headache  and  stiff  neck.  The  removal  of 
spinal  fluid  promptly  relieved  the  headache, 
which  did  not  recur,  and  on  the  following 
day  the  patient  felt  well.  Several  days  after 
discharge  from  the  hospital  he  complained 
of  visual  blurring  and  was  referred  for 
ophthalmologic  consultation  with  the  pre- 
sumptive diagnosis  of  leptospiral  iridocy- 
clitis. The  consultant  agreed  and  success- 
fully treated  the  patient  with  topical  ster- 
oid therapy.  The  subsequent  course  has 
been  uneventful. 

The  pattern  of  antibody  titer  is  shown  in 
figure  2. 

Comment 

When  the  diagnosis  was  initially  sus- 
pected,   the    patient    and    his    family    were 


questioned  in  detail  concerning  possible 
modes  of  exposure  to  the  leptospiral  organ- 
ism. His  occupation  as  a  carpenter  was  not 
considered  hazardous.  He  had  not  been 
swimming  or  wading  in  pools  or  streams 
that  might  have  been  contaminated.  Four 
hunting  dogs  were  kept  penned  on  his  pro- 
perty, but  he  admitted  little  or  no  contact 
with  them.  The  State  Board  of  Health  in- 
vestigated his  home  situation  and  initially 
determined  that  he  had  recently  helped  re- 
model an  old  house  which  was  apparently 
infested  with  rats.  The  dogs  were  bled  and 
all  found  to  be  positive  to  Lept.  canicola. 
Since  surveys  had  shown  a  percentage  of 
healthy  dogs  to  be  chronic  renal  shedders1'" 
and  since  Lept.  canicola  was  the  serotype 
apparently  responsible  for  the  patient's  ill- 
ness, it  seemed  reasonable  to  assume  that 
the  dogs  were  the  source  of  the  infection. 

Although  the  patient  was  exceedingly  un- 
comfortable, the  disease  had  a  relatively 
brief  and  benign  course.  The  iridocyclitis 
represented  the  sole  residual  defect,  and 
this  condition  cleared  with  proper  therapy. 
The  complication  has  been  previously  re- 
ported"'". The  suffusion  of  the  conjunctiva, 
which  was  present  in  85  per  cent  of  Ed- 
ward's cases'71,  actually  presented  the  first 
clue  to  the  proper  clinical  diagnosis. 

The  biphasic  course  of  the  disease  is  well 
demonstrated  by  this  case.  It  will  be  noted 
that  although  the  patient  was  clinically  im- 
proved on  the  sixth  day  of  his  illness,  he 
became  somewhat  confused  and  on  the  sub- 
sequent day  showed  obvious  physical  signs 
of  meningitis.   Whether   this   manifestation 


L.    autumnalis 

neg. 

4  + 

14- 

L.    australis  A 

- 

4  + 

1  + 

1  + 

L.   ballum 

4  + 

L.   bataviae 

3+ j 

- 

L.    canicola 

- 

4  + 

4+ 

L.   hebdomalis 

- 

3  + 

- 

L.   hyos 

- 

- 

- 

L.   icterohem 

- 

3+ 

1+ 

'  L.   pomona 

- 

3  + 

14- 

L.   pyrogenes 

- 

2  + 

- 

L.    sejroe 

- 

3* 

~I+     ~~ 

L.    grippotyph 

- 

3+ 

Day  from  onset 
of  illness 

7th. 

14th. 

26th. 

Fig.    2.    Serial    agglutination   determinations. 


August,  1960 


LEPTOSPIROSIS— LEONARD 


341 


might  be  more  properly  referred  to  as  men- 
ingoencephalitis is  not  clear  at  this  time. 

The  explanation  for  the  biphasic  pattern 
has  not  been  clarified.  There  is  apparent 
general  agreement  that  the  first-stage  man- 
ifestations are  directly  related  to  leptospi- 
remia.  A  positive  blood  culture  is  said  to  be 
possible  only  during  this  phase.  The  role  of 
hypersensitivity  in  the  pathogenesis  of  the 
second  phase  has  been  mentioned  by  sev- 
eral authors.  Middleton'71  proposed  a  hy- 
persensitivity reaction  to  account  for  the 
neurologic  lesions,  and  Davidson18'  con- 
sidered "after-fever"  to  be  an  allergic  phe- 
nomenon. Edwards' 6el  also  expressed  the 
opinion  that  the  second  stage  appeared  to 
be  the  consequence  of  the  body's  immuno- 
logic responses. 

In  this  temperate  climate  leptospiral  in- 
fections probably  have  seasonal  variation, 
in  contrast  to  the  lack  of  variation  in  trop- 
ical areas  where  animal  and  human  activ- 
ities, high  humidity,  and  temperatures  are 
more  constant.  Humbert'2'  considered  the 
wet  spring  months,  with  their  high  waters 
and  floods,  a  possible  high-incidence  period. 

Headache  is  present  in  all  and  conjunc- 
tival suffusion  in  85  per  cent  of  the  cases. 
A  macular  or  maculopapular  generalized 
eruption  appears  between  the  fourth  and 
eighth  day  in  25  per  cent.  Nonspecific  gas- 
trointestinal symptoms  are  commonly  pre- 
sent, and  a  generalized  lymphadenopathy 
occurs  in  40  per  cent.  The  incidence  of 
meningitis  in  these  cases  is  not  known,  but 
it  appears  to  develop  on  or  about  the 
seventh  day  of  illness.  Hepatomegaly,  icter- 
us, and  albuminuria  may  be  present,  but 
splenomegaly  is  rare.  Cough  is  reported  in 
25  per  cent  of  the  cases  and  pneumonitis  is 
seen  radiographically19'.  From  a  review  of 
the  available  literature,  the  pulmonary  find- 
ings do  not  appear  to  have  been  adequately 
investigated. 

From  this  summary  of  the  symptoms  and 
physical  findings  it  is  clear  that  the  syn- 
drome may  mimic  many  common  infec- 
tious diseases.  It  would  appear  that  milder 
forms  of  leptospirosis  have  gone  unrecog- 
nized, and  it  remains  for  us  to  encourage  a 
search  for  the  disease  by  simple  laboratory 
procedures  in  all  cases  of  obscure  and  un- 
explained febrile  illnesses. 


Summary 

A  case  of  leptospirosis  caused  by  Lept. 
canicola  is  reported.  It  is  considered  to  be 
the  first  such  report  from  Guilford  County. 

The  widespread  animal  reservoir  of  in- 
fection in  this  state  is  noted. 

The  diagnosis  should  be  considered  in  all 
acute  febrile  illnesses  associated  with  head- 
ache, temperature  elevation,  myalgia,  con- 
junctival suffusion,  pneumonitis,  and  where 
"asceptic  meningitis"  or  other  cerebral 
symptoms  develop  on  or  about  the  seventh 
day. 

It  is  further  suggested  that  suitable  cul- 
ture material  be  made  available  at  the  lo- 
cal county  health  level  for  possible  earlier 
diagnosis. 

References 

1.  Gochenour,  W.  S.  Jr.,  and  others:  Leptospiral  Etiology 
of  Fort  Bragg  Fever.  Public  Health  Rep.  67:811-813 
(Aug.)     1952. 

2.  Humbert.  W.  C:  Leptospirosis;  Its  Public  Health  Sig- 
nificance.   North    Carolina    M.    J.    16:406-409    (Sept.)     195B. 

3.  Division  of  Epidemiology;  North  Carolina  State  Board 
of  Health:  Leptospirosis,  Bull.,  State  Board  of  Health, 
Raleigh,    1958. 

4.  Hall,  H.  E.,  and  others:  Evaluation  of  Antibiotic 
Therapy  in  Human  Leptospirosis,  Ann.  Int.  Med.  35:981- 
998  (Nov.)  1951.  (b)  Fairburn.  A.  C.  and  Semple 
S.  J.  G. :  Chloramphenicol  and  Penicillin  in  the  Treat- 
ment of  Leptospirosis  Among  British  Troops  in  Malaya, 
Lancet  1:13-16  (Jan.  1)  1956.  (c)  Broom,  J.  C,  and 
Norris,  T.  S.:  Failure  of  prophylactic  oral  penicillin  to 
inhibit  a  human  laboratory  case  of  leptospirosis.  Lancet 
1:721-722  (April  6)  1957.  (d)  Russell,  R.  R.  W.:  Treat- 
ment of  leptospirosis  with  oxytetracyclin.  Lancet  2:1143- 
1145    (Nov.   29)    1958 

5.  Cargill,  W.  H.,  Jr.,  and  Beeson,  P.  B.:  The  Value  of 
Spinal  Fluid  Examination  as  a  Diagnostic  Procedure  in 
Weil's    Disease,    Ann.     Int.    Med.    27:396-400     (Sept.)     1947. 

6.  (a)  Sturman.  R.  M.,  Laval.  J.  and  Weil.  V.  J.:  Lepto- 
spiral Uveitis,  A.M.A.  Arch.  Ophth.  61:6633-640  (April) 
1959.  (b)  Hanno,  H.  A.,  and  Cleveland,  A.  F.  Leptospiral 
Uveitis,  Am.  J.  Ophth.  32:1564-1566  (Nov.)  1949.  (c) 
Alexander,  A.,  and  others:  Leptospiral  Uveitis,  A.M.A. 
Arch.  Ophth.  48:292-297  (Sept.)  1952.  (d)  Beeson,  P  B., 
Hankey,  D.  D.,  and  Cooper,  C.  F.,  Jr.:  Leptospiral  Iri- 
docyclitis; Evidence  of  Human  Infection  with  Leptospira 
Pomona  in  United  States,  J.  A.  M.  A.  145:229-230  (Jan. 
27)  1951.  (e)  Edwards,  G.  A.:  Clinical  Characteristics 
of  Leptospirosis,   Am.   J.   Med.   27:4-17    (July)    1959. 

7.  Middleton,  J.  E.:  Canicola  Fever  with  Neurological  Com- 
plications,   Brit.    M.    J.    2:25-26    (July    2)    1955. 

8.  Davidson,  L.  S.  P.,  and  Smith.  J.:  Weil's  Disease  in 
Fish-Workers;  A  Clinical,  Chemical  and  Bacteriological 
Study  of  40   Cases,   Quart.   J.   Med.   5:263-286    (April)    1936. 

9.  Woodard,  T.  E. :  The  Protean  Manifestations  of  Lepto- 
spirosis. U.  S.  Army  Medical  Service  Graduate  School, 
Symposium  on  the  Leptospiroses,  M.  Science  Publication 
No.  1.,  U.  S.  Government  Printing  Office,  Washington, 
D.    C,    pp.   57-71,    1953. 


.•542 


Aim-list.  1960 


Salmonella  and  Shigella  Infections  Found 
In  One  Hundred  Ninety-five  Cases  of  Acute  Diarrhea 


E.  R.  Caldwell,  Jr.,  M.D. 

and 

E.  A.  Abernathy,  M.D. 

Statesville 


In  October,  1952,  it  was  decided  that  all 
patients  admitted  to  this  small  general  hos- 
pital with  a  chief  complaint  of  diarrhea 
would  have  a  single  stool  culture  prior  to 
the  institution  of  any  therapy.  This  culture 
was  taken  from  the  first  stol  passed,  and 
therapy  was  then  started.  Blood  cultures 
were  made  in  only  a  few  selected  patients  in 
whom  the  illness  seemed  more  severe.  Rou- 
tine blood  tests  (hemoglobin  determination, 
red  blood  cell  count,  white  blood  cell  count, 
and  erythrocyte  sedimentation  rate)  and 
urinalyses  were  carried  out,  but  are  not  an- 
alyzed in  this  report.  The  study  was  con- 
ducted to  determine  the  bacteriologic  con- 
tent of  a  single  stool  culture.  It  is  realized 
that  in  private  practice  one  cannot  pursue 
as  thorough  a  bacteriologic  analysis  as  would 
be  possible  in  a  teaching  hospital ;  however, 
we  believe  that  a  single  specimen  collected 
and  mailed  to  the  State  Laboratory  may  be 
quite  revealing  in  determining  the  cause  of 
diarrhea  in  some  cases. 

Results 
Table  1  shows  that  out  of  195  cultures  23 
pathogenic  organisms  were  isolated — an  in- 
cidence of  11.8  per  cent.  Probably  this  fig- 
ure would  have  been  higher  if  repeated  cul- 
tures had  been  made.  Twelve  Salmonella  and 
11  Shigella  organisms  were  isolated.  One 
case  of  Salmonella  typhosa  was  discovered, 
but  was  not  included  in  this  series  because 
no  diarrhea  was  present.  A  diagnosis  was 
made  seriologically  and  finally  proven  bac- 
teriologically  when  a  positive  stool  culture 
was  obtained  after  several  attempts. 


From    Davis     Hospital.    Statesville.     North    Carolina. 
We    are    indebted    to    the    North    Carolina    State    L  iboratory    of 
Hygiene    for    the    bacteriologic    studies. 


Table   1 


I     Salmone 


Montevideo 

Typhimurium 

Derby 

Enteritidis 

Senftenberg 

Javiana 

II     Shigella 

Sonnei 
Flexneri 
Flexneri 
Sonnei 
Negative  Cultures 
Positive  Cultures 

Total  Cultures 


I 

3 
6 

II 


172 
23 

195 


I     Salmonella 


Typhimurium 

Montivideo 

Derby 

Enteritidis 

Senftenberg 

Javiana 

Total 


II     Shigella 


Sonnei 
Sonnei 
Flexneri 
Flexneri 


II 
6 
3 


Total 


12 


5 
1 

4 
1 

II 


Conclusions 


Though  trained  bacteriologists  are  not 
available  in  all  hospitals  and  private  office 
laboratories,  it  is  possible,  by  using  avail- 
able facilities,  to  isolate  many  pathogenic 
organisms  and  so  achieve  a  somewhat  more 
scientific  approach  to  our  practice.  It  is  grat- 
ifying to  be  able  to  make  a  definite  diag- 
nosis in  some  of  the  otherwise  obscure  types 
of  diarrhea. 


Every  human  being  has  an  innate  dread  of  illness,  and  brings  to  his 
doctor  his  fears,  his  hopes,  and  his  confidence.  Medical  care  is  very  def- 
initely a  personal  service.  Science  is  a  requisite  but  without  sympathy  is 
woefully  inadequate. — Rouse,  M.O. :  Essential  "Intangibles"  in  Medicine, 
South.  M.  J.  53:1   (Jan.)  1960. 


August,  1960 


EDITORALS 


343 


North  Carolina  Medical  Journal 

Owned  and   published   by 

The  Medical  Society  of  the  State  of  North  Carolina, 

under  the  direction  of  its  Editorial  Board. 

EDITORIAL   BOARD 
Wingate  M.  Johnson,  M.D.,  Winston-Salem 

Editor 
Miss  Louise  MacMillan,  Winston-Salem 

Assistant  Editor 
Mr.  James  T.  Barnes,  Raleigh 

Business  Manager 
Ernest  W.   Furgurson,   M.D.,  Plymouth 
John  Borden  Graham,  M.D.,  Chapel  Hill 
G.  Westbrook  Murphy,   M.D.,  Asheville 
William   M.   Nicholson,   M.D.,   Durham 
Robert  W.  Prichard,  M.D.,  Winston-Salem 
Charles  W.  Styron,  M.D.,  Raleigh 

Address  manuscripts  and  communications  regarding 
editorial  matter  to  the 
NORTH  CAROLINA  MEDICAL  JOURNAL 
300  South  Hawthorne  Road,  Winston-Salem  7,  N.  C. 
Questions  relating  to  subscription  rates,  advertis- 
ing, ect.,  should  be  addressed  to  the  Business 
Manager,  203  Capital  Club  Building,  Raleigh,  N.  C. 
All  advertisements  are  accepted  subject  to  the  ap- 
proval of  a  screening  committee  of  the  State 
Journal  Advertising  Bureau,  510  North  Dearborn 
Street,  Chicago  10,  Illinois,  and/or  by  a  Committee 
of  the  Editorial  Board  of  the  North  Carolina  Medi- 
cal Journal  in  respect  to  strictly  local  advertising 
accepted  for  appearance  in  the  North  Carolina 
Medical  Journal. 

Annual  subscription,  $5.00  Single  copies,  75c1 

Publication    office:    Carmichael    Printing    Co.,    1309 

Hawthorne  Road,  S.W.,  Winston-Salem  1,  N.  C. 

August,  1960 


NAMING  NEW  DRUGS 

The  rapid  multiplication  of  new  drugs  is 
creating  a  real  problem  for  physicians, 
medical  students,  and  pharmacists.  It  is 
well  nigh  impossible  to  memorize  even  the 
names  of  the  hundreds  of  new  preparations 
marketed  every  year — much  less  to  learn 
their  indications,  contraindication,  side-ef- 
fects, and  dosage.  The  confusion  is  com- 
pounded by  the  fact  that  every  drug  has  at 
least  three  names:  chemical,  generic,  and 
brand.  The  chemical  names,  while  admit- 
tedly more  scientific,  have  a  very  limited 
application  for  the  average  medical  man. 
Generic  is  used  in  the  sense  of  Webster's 
definition,  "General ;  opposed  to  specific." 
The  brand  names  are  selected  by  the  manu- 
facturers and  are  copyrighted.  As  an  ex- 
treme example,  there  are  more  than  18 
brand  names  for  reserpine.  If  a  doctor  pre- 
scribes a  drug  by  its  generic  name,  the 
druggist  is  not  obligated  to  use  the  product 
of  any  one  manufacturer.  If,  however,  the 
brand  name  is  used,  the  druggist  must  use 
the  one  specified. 


The  manufacturers  seek  to  justify  the 
use  of  brand  names  as  necessary  to  insure 
that  the  drug  meets  the  proper  standards 
in  its  preparation  and  that  inferior  pro- 
ducts are  not  sold.  The  widespread  use  of 
copyright  brands,  however,  imposes  a  hard- 
ship on  the  doctor,  who  has  trouble  enough 
remembering  simple  generic  names;  on  the 
druggist,  who  must  carry  in  stock  many 
forms  of  the  generic  drug ;  and  on  the  con- 
sumer, who  must  pay  more  for  the  addition- 
al expense  entailed  in  marketing  and  adver- 
tising the  product. 

The  Advertising  Committee  of  the  New 
England  Journal  of  Medicine  (vol.  263:1, 
July  7,  1960)  offers  a  most  constructive  so- 
lution of  this  problem  of  naming  new 
drugs.  A  special  article,  "Drug  Terminol- 
ogy and  the  Urgent  Need  for  Reform,"  con- 
cludes with  the  following  pertinent  sugges- 
tions: 

The  generic  term  must  be  selected  and  made 
available  for  every  new  drug  before  it  is  put  on 
the  market.  This  should  be  a  requirement  of  the 
Food  and  Drug  Administration.  Generic  names 
should  be  selected  by  a  National  Advisory  Com- 
mittee appointed  by  the  Food  and  Drug  Admin- 
istration. This  committee  should  consist  of  ex- 
perts in  medicine,  pharmacy,  psychology  and 
marketing.  The  terms  must  be  brief  and  de- 
signed with  regard  for  their  dignity,  visual  and 
oral  reception  and  mnemonic  connotations.  Cer- 
tainly, such  an  expert  committee  could  design 
much  better  generic  terminology  than  is  at  pre- 
sent available. 

Once  the  generic  term  is  selected  and  adopted 
it  must  represent  the  highest  standards  avail- 
able for  that  product  .  .  .  Once  this  is  done  the 
physician  can  be  certain  of  the  drug  his  patient 
will   receive. 

The  medical  profession  should  engage  in  a 
campaign  to  urge  physicians  to  give  generic 
names  prominence  in  all  medical  writing,  adver- 
tising and  usage.  Medical  journal  editors  should 
join  in  this  campaign  and  see  to  it  that  generic 
terminology  is  the  terminology  of  choice  in  ad- 
vertising. 

A  monthly  glossary  of  generic  names  and  the 
standards  that  they  represent  should  be  pub- 
lished in  leading  medical  journals  and  perhaps 
sent  to  physicians  by  the  Food  and  Drug  Ad- 
ministration. 

Finally,  many  medical  authorities  agree  that 
inclusion  of  the  manufacturer's  name  after  the 
generic  name  would  in  the  end  give  him  equal 
protection  and  even  more  favorable  recognition 
than  the  present  undesirable  trade-name  prac- 
tice. For  the  belief  is  growing  that  a  manu- 
facturer's reputation  and  good  will  are  asso- 
ciated rather  with  his  company   name   than  with 


344 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,  1960 


fanciful  copyrighted  and  generally  inane  neolog- 
isms. 

As  Editor  Joseph   Garland   comments   in 
the  same  issue: 

If  manufacturers  will  have  only  enough  faith 
in  themselves  to  rely  on  their  institutional  re- 
putation to  assure  the  purchaser  that  their  par- 
ticular product  is  an  especially  reliable  one,  they 
will  almost  certainly  gain  additional  prestige 
with  the  professional  men  and  women  whom 
they  are  trying  to   impress. 

With  the  scrupulous  observance  of  such  poli- 
cies the  management  of  drug  therapy  would  be 
even  more  solidly  vested  in  the  medical  profes- 
sion, where  all  would  agree  that  it  belongs.  It 
may  be  expected  that  the  advertiser  who  ap- 
peals to  the  intelligence  of  his  professional  clien- 
tele will  not  lose  by  such  a  display  by  confidence. 
It  is  devoutly  to  be  wished  that  these 
constructive  suggestions  of  our  New  Eng- 
land contemporary  will  be  accepted. 


chiatric  service.  The  number  had  increased 
to  200  by  the  end  of  World  War  II,  in  1945, 
and  by  1957  there  were  584.  Many  more 
have  let  down  their  bars  since  then.  In 
some  of  these  the  psychiatric  division  is 
closed,  but  in  perhaps  most  of  them  it  is 
open,  and  patients  may  be  given  insulin  and 
electroshock  therapy  in  their  rooms. 

Any  doctor  who  has  had  to  deal  with 
"borderline"  cases,  such  as  mental  depres- 
sion or  anxiety  states,  can  appreciate  the 
advantage  of  having  such  patients  in  a  gen- 
eral hospital.  And  as  the  Southern  Medical 
Journal  editorial  points  out,  the  admission 
of  psychiatric  patients  to  a  general  hospital 
has  educational  and  training  value  both  for 
the  psychiatrist  and  for  the  house  staff.  It 
will  be  gratifying  to  see  the  increasing  use 
of  general  hospital  beds  for  mentally  ill  pa- 
tients. 


THE  ARTHRITIS  HOAX 

The  Public  Affairs  Committee,  a  nonprof- 
it organization,  in  cooperation  with  the 
Arthritis  and  Rheumatism  Foundation,  has 
prepared  a  20-page  pamphlet,  "The  Arthri- 
tis Hoax,"  which  exposes  the  many  ways 
by  which  victims  of  arthritis  are  exploited 
to  the  tune  of  more  than  250  million  dol- 
lars a  year  by  worse  than  useless  drugs,  de- 
vices, and  treatments,  ranging  from  copper 
bracelets  to  "uranium  mines,"  and  from 
dietary  fads  to  analgesic  drugs.  The  pam- 
phlet is  sold  for  20  cents  by  the  Public  Af- 
fairs Committee— 22  East  38th  Street,  New 
York  16.  It  gives  the  answers  to  many  of 
the  questions  that  patients  are  apt  to  ask 
the  doctor,  and  is  well  worth  the  price. 


PSYCHIATRIC  PATIENTS  IN 
A   GENERAL   HOSPITAL 

"  'Tis  true,  'tis  pity;  and  pity  'tis,  'tis 
true"  that  there  is  a  certain  stigma  at- 
tached to  being  treated  in  a  hospital  de- 
voted entirely  to  mentally  ill  patients.  The 
psychic  trauma  of  such  an  experience  may 
intensify  the  patient's  illness — especially  in 
mental  depression,  which  is  one  of  the  most 
frequent  ailments  for  which  doctors  are 
consulted.  It  is  a  cause  for  giving  thanks 
that  so  many  general  hospitals  now  admit 
psychiatric  patients. 

An  editorial  in  the  July  Southern  Medical 
Journal  states  that  at  the  turn  of  the  cen- 
tury only  25  general  hospitals  had  a   psy- 


THREE   CORRECTIONS 

Three  mistakes  were  made  in  the  June 
issue  editorial,  One  Hundredth  Sixth  An- 
nual Session. 

1.  That  the  wrist  watch  presented  Jim 
Barnes  was  a  gift  from  the  Society.  The 
watch  was  given  him  by  the  past  presidents 
who  have  served  with  him  since  he  became 
our  Executive  Secretary,  as  a  token  of  their 
appreciation   of  his  ability. 

2.  The  statement  that  Billy  Joe  Patton 
was  Dr.  Leonard  Larson's  son-in-law.  Mrs. 
Patton  is  a  sister  of  Mr.  John  Collett  of 
Lenoir,  and  Mrs.  Collett  is  Dr.  Larson's 
daughter.  Although  the  editor's  face  is  red, 
he — and  all  other  North  Carolina  doctors — 
is  glad  to  know  that  Dr.  Larson,  now  Pres- 
ident-elect of  the  American  Medical  Asso- 
ciation, does  have  a  daughter  living  in  the 
state,  who  will  be  a  strong  inducement  for 
him  to  visit  us  often. 

3.  The  most  serious  error  was  a  proof- 
reading lapse.  The  statement  that  the  mo- 
tion to  table  the  resolution  from  the  Lenoir 
Jones-Green  Component  Society  to  limit 
the  term  of  councilors  "was  defeated  by  a 
vote  of  55  to  48"  should  have  read,  "was 
passed  by  a  vote  of  55  to  48." 

Three  boners  in  one  editorial  is  a  record 
of  which  the  editor  is  thoroughly  ashamed 
— and  for  which  he  has  no  one  to  blame  but 
himself.  He  can  only  promise  to  try  to  do 
better  in  the  future. 


August,  1960 


EDITORALS 


345 


DR.   PRESTON— NEW  EDITOR   OF 
HEALTH  BULLETIN 

In  1942  Dr.  John  H.  Hamilton  added  to 
his  other  duties  as  Assistant  State  Health 
Director  and  Director  of  the  State  Labora- 
tory of  Hygiene  the  editorship  of  The 
Health  Bulletin.  When  the  time  came  for 
him  to  retire  for  chronologic  reasons,  the 
very  satisfactory  way  he  has  filled  all  three 
positions  was  recognized  in  an  appreciation 
from  the  State  Board  of  Health.  This  was 
published  in  the  May  Health  Bulletin  to- 
gether with  his  picture  on  the  cover — with- 
out his  knowledge  or  consent.  This  same  ap- 
preciation appeared  in  the  June  issue  of 
the  North  Carolina  Medical  Journal. 

The  Board  of  Health  was  fortunate  in 
being  able  to  fill  Dr.  Hamilton's  place  with- 
out delay.  Edwin  S.  Preston,  M.  A.,  LL.  D., 
who  has  been  selected  to  succeed  Dr.  Ham- 
ilton is  well  qualified  for  the  position.  For 
eight  years  he  edited  the  Public  Welfare 
News,  the  official  publication  of  the  North 
Carolina  Board  of  Public  Welfare.  He  was 
also  the  Welfare  Board's  public  relations 
officer.  In  December,  1959,  he  came  to  the 
State  Board  of  Health  as  its  public  rela- 
tions officer — so  he  is  a  "natural"  for  the 
editorship  of  the  Bulletin. 

Dr.  Preston  is  a  graduate  of  the  Univer- 
sity of  Tennessee  and  has  an  M.  A.  degree 
from  Mercer  University.  The  honorary  de- 
gree of  LL.  D.  was  conferred  by  Baylor 
University.  This  journal  echoes  the  words 
used  by  Dr.  Roy  Norton  in  the  June  Health 
Bulletin,  introducing  him  to  the  readers 
of  the  Bulletin.  Dr.  Norton  bespoke  for  Dr. 
Preston  "the  same  fine  and  helpful  criti- 
cism and  assistance  that  has  been  given  to 
his  predecessor  by  the  friends  who  receive 
The  Health  Bulletin." 


"YOU  ARE  OLD,  FATHER  WILLIAM  .  ."* 

Not  so  long  ago,  it  seems,  old  people  were 
just  old  people,  gentle,  withering  relics  of 
the  past  typified  by  Whistler's  portrait  of 
his  mother.  True,  they  had  their  problems 
then,  but  who  hadn't?  Some  were  incapa- 
citated, other  spry ;  some  were  broke,  others 
solvent;  some  were  happy,  some  sad. 

Now  our  modern  old  people,  more  nu- 
merous than  before,  thanks  to  modern  doc- 
tors,  modern  medical   science,   and   modern 


•Reprinted    from    the   New    York    State    Journal    of    Medicine. 
May    15.    1960. 


private  enterprise  in  medicine,  have  been 
metamorphosed.  From  being  just  old  peo- 
ple they  have  become  recently  desirable, 
valuable  political  assets!  Each  has  a  genu- 
ine exercisable  franchise;  some  15,000,000 
potentially  purchasable  ballots !  Purchas- 
able by  inducement — not  in  cash  but  by 
"benefits." 

Both  major  political  parties  are  offering 
bids,  the  Democrats  a  Forand-type  bill,  the 
Republicans  a  Javits-type  bill.  Suddenly  the 
health  of  the  aged  becomes  the  grave  con- 
cern of  others  besides  the  doctors. 

Assuredly  the  old  folks  have  not  offered 
their  votes  for  sale;  the  most  many  ask  for 
is  the  privilege  of  continuing  to  work  gain- 
fully after  sixty-five,  not  for  a  pittance  but 
according  to  their  ability  to  earn  and  to  pay 
their  taxes,  employ  their  own  doctors,  and 
buy  their  own  insurance. 

In  all  the  election  year  turmoil  over  the 
health  of  the  old  who  hears  any  concern 
expressed  over  the  employers,  the  business 
men,  the  small  and  large  shop  operators, 
and  others,  men  who  create  employment  for 
the  young?  In  this  election  year  and  every 
year,  many  thousands  of  young  people  will 
for  the  first  time  have  fastened  about  their 
necks  the  yoke  of  withholding  taxes,  Social 
Security  taxes,  rent,  state,  local  taxes,  union 
dues,  and  the  national  debt.  The  young — 
don't  they  enjoy  the  prospect  of  some  forty- 
seven  years  of  work-filled  and  tax-ridden 
pursuit  of  happiness? 

The  young  people — will  they  not  find  it 
increasingly  difficult  in  this  inflation-ridden 
election  year  and  those  to  follow  to  buy 
bread  for  themselves  and  their  children? 
Who  cares?  Let  them  eat  cake!  They  are 
only  the  young.  Will  they  find  in  their  midst 
anyone  to  arise  and  say  in  a  loud  voice  to 
politicians  of  both  parties:  Thou  shalt  not 
press  down  upon  the  brow  of  youth  a  crown 
of  aging  thorns! 


NORTH   CAROLINA'S   COMMITTEE 
ON  MEDICAL  CREDIT  BUREAUS 

The  May  issue  of  the  A.M.A.'s  PR  Doc- 
tor devotes  more  than  two  columns  to  a 
very  favorable  discussion  of  the  work  done 
by  the  Medical  Credit  Bureau  Committee 
of  our  State  Society,  of  which  Dr.  Howard 
Wilson  of  Raleigh  is  the  chairman.  Dr. 
Wilson  and  his  committee  deserve  much 
credit  for  their  fine  work. 


340 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,  1900 


Committees  and  Organizations 


North  Carolina  Board  of 
Medical  Examiners 

THE  BIENNIAL  REGISTRATION  ACT 

The  second  registration  of  physicians  in 
North  Carolina  was  completed  in  January, 
1960.  The  registration  went  along  smooth- 
ly. The  directory  has  been  completed  and 
mailed  to  each  physician.  However,  some 
of  our  friends  exercised  their  inalienable 
right  to  register  their  objections  to  the  reg- 
istration. These,  however,  seemed  to  for- 
get that  this  law  was  sponsored  by  the  Med- 
ical Society,  under  the  directive  of  the 
House  of  Delegates  of  1956.  The  complain- 
ant is  usually  concerned  only  with  the  fact 
that  he  has  to  pay  a  fee  and  does  not  con- 
sider what  is  best  for  the  group  as  a  whole. 
It  is  a  recognized  principle  of  all  people 
who  deal  with  licensure  that  registration  is 
necessary  to  keep  the  records  and  the  office 
running  smoothly  for  the  benefit  of  all  phy- 
sicians. Registration  was  not  put  into  effect 
as  a  revenue  measure,  but  all  the  funds  go 
into  the  treasury  of  the  Board  and  thereby 
enable  the  Board  to  serve  better  the  phy- 
sicians and  all  citizens  of  the  State  of 
North  Carolina. 

A  native  son  recently  returned  to  North 
Carolina  for  practice.  He  had  been  away  so 
long  he  did  not  know  of  the  registration. 
When  he  registered,  the  office  noted  that  an 
official  notice  had  been  received  from  the 
secretary  of  a  board  of  medical  examiners 
of  a  distant  state  that  this  physician's  li- 
cense had  been  revoked,  but  sentence  had 
been  suspended  on  conditions.  The  Board 
has  interviewed  this  physician.  He  has  an 
opportunity  for  rehabilitation  under  super- 
vision. 

The  law  as  enacted  was  a  compromise 
draft  to  overcome  the  objections  presented 
to  the  Legislative  Committee  of  the  Med- 
ical Society.  The  result  has  been  that  the 
Board  has  been  embarrassed  on  a  number 
of  occasions  by  not  having  the  power  to 
waive  the  penalty  under  conditions  upon 
which  some  people  were  late  in  registering. 
The  other  professions  and  trades  in  North 
Carolina  controlled  by  a  board  have  annual 
registration.  Their  fees  equal  or  are  more 
annually  in  the  majority  of  the  cases  than 
the  fee  which  the  physician  pays  every  two 
years. 


The  Board  wishes  to  express  its  appre- 
ciation to  the  leaders  of  the  Medical  Society 
of  the  State  of  North  Carolina,  to  the  edi- 
torial staff  of  our  Journal,  and  to  the 
greater  majority  of  the  physicians  of  this 
state  who  have  accepted  and  co-operated 
with  this  registration.  It  will  be  our  aim  to 
continue  to  serve  the  citizens  of  our  state 
in  our  official  capacity  as  a  part  of  the  state 
government. 

Joseph  J.  Combs,  M.D.,  Secretary 

North  Carolina  Board 

of  Medical  Examiners 


BULLETIN  BOARD 


COMING  MEETINGS 

State 

North  Carolina  and  South  Carolina  Eye,  Ear, 
Nose  and  Throat  Societies'  Annual  Joint  Meeting 
— Hotel   King:  Cotton,  Greensboro,   September  11-14. 

Fourth  District  Medical  Society  Meeting — Wil- 
son, September  14. 

North  Carolina  Urological  Association,  Annual 
Meeting — Greystone  Inn,  Roaring-  Gap,  September 
25-26. 

North  Carolina  Fifth  District  Medical  Society 
Meeting — Mid    Pines    Club,    Pinehurst,    October   5. 

North  Carolina  Society  for  Crippled  Children 
and  Adults,  Twenty-fifth  Annual  Meeting — Wash- 
ington Duke  Hotel,   Durham,   October  6-8. 

A.M. A.  Twentieth  Annual  Congress  on  Industrial 
Health— Charlotte,   October    10-12. 

Duke  University  Medical  Postgraduate  Seminar 
Cruise  to   the   West    Indies — November   9-18. 

North  Carolina  Academy  of  General  Practice, 
Annual  Meeting — Carolina  Hotel,  Pinehurst,  No- 
vember 27-30. 

Regional   and    National 

Fifth  International  Congress  on  Nutrition — ■ 
Sheraton  Park  and  Shoreham  Hotels,  Washington, 
D.C.,    September    1-7. 

Southern  Trudeau  Society  and  Southern  Tuber- 
culosis Society  Meeting — Hotel  Francis  Marion, 
Charleston,   South   Carolina,    September    14-16. 

A.M. A.  First  Regional  Conference  on  Rural 
Health,  Atlanta,  Georgia,  October  7-8. 

American  Rhinologic  Society,  Sixth  Annual 
Meeting — Belmont  Hotel,   Chicago,   October   8. 

American  College  of  Surgeons,  Forty-sixth  An- 
nual Clinical  Congress — San  Francisco,  October 
10-14. 

Southeastern  Allergy  Association,  Annual  Meet- 
ing— Atlanta  Biltmore  Hotel,  Atlanta,  Georgia, 
October   21-22. 

Southern  Medical  Association,  Fifty-fourth  An- 
nual Meeting — Saint  Louis,  Missouri,  October  31- 
November   3. 

Sixty-seventh     Annual     Convention     of     Military 


August,  1960 


BULLETIN  BOARD 


347 


Surgeons — Washing-ton,  D.C.,  October  31-Novem- 
ber  2. 

American  Medical  Writers'  Association,  Seven- 
teenth Annual  Meeting — Morrison  Hotel,  Chicago, 
November  18-19. 

Southeastern  Region  of  the  College  of  Ameri- 
can Pathologists  and  the  Virginia  Society  of 
Pathologists,  Seminar  on  Kidney  Diseases — John 
Marshall   Hotel,   Richmond,   November  25-26. 


New  Members  of  the  State  Society 

The  following  new  physicians  joined  the  Medical 
Society  of  the  State  of  North  Carolina  daring  the 
month  of  July. 

Dr.  Charles  Bodine  Neal,  III,  Duke  University 
School  of  Medicine,  Durham;  Dr.  John  William  Or- 
mand,  Jr.,  309  Lancaster  Avenue,  Monroe;  Dr. 
William  Thomas  Rice,  318  Mocksville  Ave.,  Salis- 
bury; Dr.  Sigurd  Carl  Sandzen,  McCain  Sanator- 
ium, McCain;  Dr.  Casper  Carl  Warren,  Jr.,  2016 
Pershing  St.,  Durham;  Dr.  Daniel  Whitaker  Davis, 
1415  Ida  Street,  Durham;  Dr.  George  Wesley  Gen- 
try, Jr.,  607  S.  Main  St.,  Roxboro;  Dr.  Stuart  Boat- 
wright,  Haywood  County  Hospital,  Waynesville; 
Dr.  Joe  Walton  Frazer,  Jr.,  838  N.  Elm  St., 
Greensboro;  Dr.  Howard  Scheyer  Wainer,  1001  N. 
Elm  St.,  Greensboro;  Dr.  George  Carl  Alderman, 
1019   Hawthorne   Road,   Wilmington. 


News  Notes  from  the  University  of 
North  Carolina  School  of  Medicine 

Several  University  of  North  Carolina  School 
faculty  members  are  engaged  in  mid-summer  work 
in  various  parts  of  the  world. 

Dr.  Hans  H.  Strupp,  director  of  psychological 
services  in  the  School  of  Medicine,  has  been 
awarded  a  grant  from  the  National  Institute  of 
Mental  Health  to  organize  a  second  conference  on 
research  in  psychotherapy  to  be  held  in  Chapel 
Hill  next  spring.  The  conference  will  be  sponsored 
by  the   American   Psychological   Association. 

Dr.  Carl  E.  Anderson,  professor  of  biochemistry, 
is  serving  as  a  visiting-  scientist  in  the  laboratory 
of  nutrition  and  endocrinology  at  the  National  In- 
stitutes of  Health  in  Bethesda,  Maryland. 

Dr.  Colin  G.  Thomas,  Jr.,  associate  professor  of 
surgery,  and  Dr.  Judson  J.  Van  Wyk,  associate 
professor  of  pediatrics,  are  in  London  to  partici- 
pate in  the  fourth  International  Goiter  Conference 
meeting. 

Dr.  Ernest  Craige,  associate  professor  in  the 
Department  of  Medicine,  has  returned  from  South 
America  where  he  served  as  a  visiting  professor 
in  the  Department  of  Internal  Medicine  at  the 
University  of  Del  Valle  in  Cali,  Colombia. 

Leaving  in  August  for  Alexandria,  Egypt,  Dr. 
Sidney  S.  Chipman,  clinical  professor  of  pediatrics, 
will  begin  a  one-year  foreign  teaching  assignment 
sponsored  by  the  World  Health  Organization.  He 
will  act  as  a  visiting  professor  of  social  pediatrics 
at  the  Higher  Institute  of  Public  Health. 


A  recent  issue  of  a  Swiss  medical  journal  con- 
tains an  article  by  Dr.  John  A.  Ewing,  associate 
professor  of  psychiatry  at  the  University  of  North 
Carolina  School   of  Medicine. 

The  article,  entitled  "Nos  malades  et  nos  con- 
tacts personnels  avec  eux,"  appears  in  Medecine 
et  Hygiene,  which  is  printed  in  Geneva. 

In  his  paper  Dr.  Ewing  explains  how  the  phy- 
sician needs  to  learn  to  observe  his  feelings  about 
his  patients.  Some  feelings  may  arise  because  of 
factors  within  the  doctor,  or  his  patient  may  re- 
mind him  of  someone  else.  Some  patients  frequent- 
ly provoke  special  feelings  in  other  people  in  al- 
most  all   personal  contacts. 

If  the  physician  is  to  control  the  relationship 
and  to  use  it  for  therapeutic  purposes,  he  must 
observe  and  identify  his  feelings  about  his  patient, 
Dr.  Ewing-  points  out.  The  way  the  patient 
"makes"  the  doctor  feel  about  him  can  be  seen  as 
similar  to  any  symptom  about  which  the  patient 
may  complain.  The  physician  needs  to  understand 
this  aspect  of  the  patient  as  much  as  anything 
else  he  finds  in  his   examination,  he   said. 

*  *     * 

Dr.  John  K.  Spitznagel  of  the  University  of 
North  Carolina  School  of  Medicine  recently  gave 
a  seminar  at  the  University  of  Florida  in  Gaines- 
ville, Florida,  where  he  spoke  on  "The  Role  of 
Basic  Proteins  in  Non-specific  Resistence  to  In- 
fection." 

Dr.  John  H.  Schwab,  assistant  professor  of  bac- 
teriology of  the  University  of  North  Carolina 
School  of  Medicine,  has  gone  to  England  to  do  a 
year's  research  at  the  Lister  Institute  of  Preven- 
tive Medicine  in  London.  He  will  work  in  the  area 
of   natural  resistence   to   infections. 

*  *     * 

A  new  brochure  has  been  issued  by  the  Univer- 
sity of  North  Carolina  Division  of  Health  Affairs 
which  gives  a  thumbnail  sketch  of  the  various  edu- 
cational programs  being  offered  by  the  University 
Medical   Center. 

Designed  primarily  for  high  school  and  junior 
colleg-e  students,  the  illustrated  brochure  ranges 
in  content  matter  from  the  one-year  training  pro- 
gram for  dental  assistants  to  the  specialized  pro- 
grams for  medical  doctors. 

Copies  are  available  to  students,  educators  and 
other  interested  persons.  They  may  be  obtained  by 
writing  to  the  U.N.C.  Director  of  Admissions  or 
to  the   School   of  Medicine. 

Ellen  Anderson  of  the  University  of  North  Car- 
olina School  of  Medicine  was  named  president- 
elect of  the  American  Society  of  Medical  Tech- 
nologists at  the  annual  convention  of  the  organi- 
zation  in    Atlantic   City,   New   Jersey  recently. 

She  will  hold  this  office  for  one  year  and  then 
be  installed  as  president  of  the  professional  society, 
which  has  8,000  members.  The  convention  was  at- 
tended by  2,000  medical   technologists. 


::  is 


NORTH  CAROLINA   MEDICAL  JOURNAL 


Aujrust.  1960 


Since  1953  Miss  Anderson  has  been  chief  cyto- 
technologist  in  the  Department  of  Pathology  and 
at  the   North   Carolina  Memorial   Hospital. 

*  *  :!= 

Four  faculty  members  of  the  section  of  Physical 
Therapy  of  the  University  of  North  Carolina 
School  of  Medicine  attended  the  national  confer- 
ence of  the  American  Physical  Therapy  Associa- 
tion in  Pittsburgh  recently.  They  were  Miss  Mar- 
garet Moore,  head  of  the  section;  Miss  Rachel 
Nunley,  Miss  Mildred  Wood,  and  Miss  Enola  Sue 
Flowers. 

Miss  Moore  addressed  the  Public  Health  Section 
of  the  Conference  on  "Public  Health  in  Physical 
Therapy  Education."  She  also  attended  a  number 
of  sessions  of  the  Council  of  Physical  Therapy 
School  Directors,  which  also  met  in  Pittsburgh 
during-  the   association   meeting. 

Miss  Wood  is  chairman  of  the  Committee  on 
Graduate  Study  of  the  American  Physical  Therapy 
Association  and  she  reported  on  the  activities  of 
the  association  in  this  field. 

Dr.  Charles  E.  Flowers  of  the  Department  of 
Obstetrics  and  Gynecology  addressed  a  meeting 
of  the  Continental  Gynecologic  Society  in  Mon- 
treal, Canada,  on  June  27-28.  His  topic  was  "Mag- 
nesium   Sulfate   Therapy   During    Pregnancy." 

Dr.  Harrie  R.  Chamberlin  of  the  Department  of 
Pediatrics  spoke  before  a  seminar  at  the  West 
Virginia  University  School  of  Medicine  in  Mor- 
ganton,  West  Virginia  on  June  29-30.  His  topic- 
was  "Intrauterine  Development  and  Environment." 
The  seminar  is  sponsored  by  the  West  Virginia 
State  Department  of  Health  and  the  Children's 
Bureau  of  the  U.  S.  Department  of  Health,  Educa- 
tion and  Welfare. 

*  *     * 

A  new  book  entitled  "Psychotherapists  in  Ac- 
tion" has  been  published  concerning  the  research 
program  being  conducted  by  an  associate  professor 
of  psychology  in  the  Department  of  Psychiatry  at 
the  University  of  North  Cai-olina  School  of  Medi- 
cine. 

The  work  is  by  Dr.  Hans  H.  Strupp,  who  also 
is  director  of  psychological  services  of  North  Car- 
olina Memorial  Hospital  here  at  the  University. 
The  publishers  are  Grune  and  Stratton  of  New 
York. 

This  volume  deals  with  how  psychiatrists  and 
psychologists  arrive  at  various  conclusions  and 
judgments  on  the  cases  which  they  are  treating 
psychologically,  and  how  they  communicate  with 
their  patients. 

Dr.  Strupp  worked  with  some  200  psychothera- 
pists in  collecting-  material  for  this  book.  Selected 
reports  from  some  40  of  these  persons  are  con- 
tained in  this  volume. 

*  *     * 

Dr.  Carl  W.  Gottschalk,  associate  professor  of 
medicine,  is  transferring  his  research  relating  to 
kidney  functions   from   Chapel   Hill   to   the   Univer- 


sity of  Copenhagen,  Denmark,  for  a   period   of  one 
year. 

In  Denmark,  Dr.  Gottschalk  will  be  associated 
with  Dr.  Hans  Ussing  of  the  Institute  of  Biolog- 
ical Chemistry  at  the  University  of  Copenhagen. 
The  year's  program  is  co-sponsored  by  the  Amer- 
ican Heart  Association  and  the  U.  S.  Public  Health 
Service. 


News  Notes  from  the  Bowman  Gray 
School  of  Medicine  of 
Wake  Forest  College 

Dr.  Donald  M.  Hayes,  instructor  in  medicine, 
has  been  appointed  assistant  dean  of  the  Bowman 
Gray  School  of  Medicine.  In  his  new  work,  Dr. 
Hayes  will  be  responsible  for  student  admissions 
and  premedical  relations.  He  will  continue  as  a 
full-time  member  of  the  Department  of  Internal 
Medicine  with  active  participation  in  teaching,  and 
research  in  hematology. 

Dr.  Hayes  is  a  1951  graduate  of  Wake  Forest 
College  and  received  his  medical  degree  from 
Bowman  Gray.  He  has  taken  postgraduate  train- 
ing in  medicine  at  the  Salt  Lake  County  General 
Hospital,  Salt  Lake  City,  Utah,  and  served  as  a 
U.  S.  Public  Health  Service  Fellow  in  Psychiatry 
for  one  year  at  the  Louisville  General  Hospital, 
Louisville,  Kentucky.  In  1958  he  completed  his  in- 
ternal medicine  residency  at  the  North  Carolina 
Baptist  Hospital. 

For  the  past  two  years  Dr.  Hayes  has  served 
as  a  hematologic  fellow  in  medicine  at  Bowman 
Gray,  and  for  the  past  year  has  been  instructor  in 

medicine. 

*     *     * 

A  total  of  $19,440  has  been  received  for  five 
cancer  traineeships  for  young  physicians  in  the 
Departments  of  Medicine,  Obstetrics-Gynecology, 
Pathology,  Radiology,  and  Surgery  at  the  Bowman 
Gray  School  of  Medicine. 

This  training  program  has  been  established  by 
the  National  Cancer  Institute  in  order  to  increase 
the  number  of  persons  with  broad  medical  exper- 
ience and  special  orientation  in  cancer. 

The  recipients  of  the  traineeships  for  this  year 
are:  Drs.  Edwin  L.  Auman,  Department  of  Medi- 
cine; J.  Howard  Young,  Department  of  Obstetrics- 
Gynecology;  Robert  S.  Pool,  Department  of  Pa- 
thology; Samuel  D.  Pendergrass,  Department  of 
Radiology;  and  Richard  F.  Bowling,  Department 
of  Surgei-y. 

Dr.  Camillo  Artom,  professor  of  biochemistry, 
and  Dr.  Hugh  B.  Lofland,  assistant  professor  of 
biochemistry,  are  the  co-authors  of  a  paper  which 
was  presented  at  the  Fifth  Conference  on  the  Bio- 
chemical Problems  of  Lipids  held  in  Marseilles, 
France,  July  21-23.  The  title  of  their  paper  is 
"Incorporation  of  Ethanolamine  and  Phosphory- 
lethanolamine  into  the  Phospholipids  of  Liver 
Preparations." 


August,  1960 


BULLETIN  BOARD 


349 


Dr.  Richard  G.  Kessel,  instructor  in  anatomy, 
has  been  awarded  a  postdoctoral  fellowship  by  the 
Division  of  General  Medical  Sciences  of  the  U.  S. 
Public  Health  Service.  These  fellowships  are 
awarded  to  assist  in  the  development  of  promising- 
investigators  in  basic  science  fields.  Dr.  Kessel's 
special    research    interest    and    training    have    been 

in  electron   microscopy. 

*     *     * 

The  U.  S.  Public  Health  Service  has  awarded  a 
grant  of  $19,665  to  Dr.  Robert  P.  Morehead,  di- 
rector of  the  Department  of  Pathology,  and  Dr. 
J.  H.  Smith  Foushee,  assistant  professor  of 
pathology.  The  official  title  of  the  grant  is,  "Com- 
munity Cancer  Demonstration  Project  Grant  to 
Train   Cytotechnicians." 

For  some  time  now,  the  Bowman  Gray  School 
of  Medicine  has  supported  the  training  of  a  lim- 
ited number  of  student  in  exfoliative  cytotechnol- 
ogy,  and  this  grant  will  permit  expansion  of  the 
training  program  and  an  increase  in  the  number 
of  students. 


News  Notes  from  the  Duke  University 
Medical  Center 

A  pilot  study  aimed  at  helping  persons  disfig- 
ured by  injury  or  disease  has  been  initiated  at  the 
Duke   University   Medical    Center. 

The  study  is  being  conducted  by  the  Center's 
Department  of  Medical  Art  and  Illustration  with 
financial  support  from  the  Office  of  Vocational  Re- 
habilitation, U.  S.  Department  of  Health,  Educa- 
tion and  Welfare.  Prof.  Elon  Clark  is  head  of  the 
department. 

Purpose  of  the  project  is  to  work  toward  the 
production  of  better  artificial  noses,  and  other 
parts  of  the  face. 

Research  funds  amounting  to  $39,900  have  been 
awarded  to  Duke  University  by  the  National 
Science  Foundation  to  support  continuing  investi- 
gations  of  brain  functions. 

Dr.  Talmadge  L.  Peele,  associate  professor  of 
anatomy  in  the  Duke  Medical  Center,  is  pi-incipal 
investigator  for  the  project.  Entitled  "Interde- 
pendence of  Amygdala  and  Hypothalamus,"  the 
research  study  is  concerned  with  learning  more 
about  the  relationships  between  these  two  parts 
of  the  brain. 

F.  Ross  Porter,  director  of  the  Duke  Medical 
Center  Foundation,  has  resigned  to  accept  a  posi- 
tion as  hospital  advisor  with  the  International  Co- 
operation  Administration. 

He  will  begin  his  first  assignment  in  Bogota, 
Colombia,  early  next  year  after  several  months  of 
orientation  and  other  preparation.  His  duties  will 
be  to  work  with  the  ICA  and  the  Colombian  gov- 
ernment in  developing  a  national  pattern  for  im- 
provement of  hospital  and  health  services  in  Co- 
lombia. 


A.M.A.  INDUSTRIAL  HEALTH  CONGRESS 
The  Twentieth  Annual  Congress  on  Industrial 
Health  will  be  held  in  Charlotte,  North  Carolina, 
October  10-12,  under  the  sponsorship  of  the  Coun- 
cil on  Occupational  Health  of  the  American  Med- 
ical  Association. 

The  program  will  include  discussions  of  occupa- 
tional health  in  agriculture,  mental  and  emotional 
health  in  industry,  problems  in  dermatitis  in  farm 
and  industry,  and  occupational  health  problems  in 
small  employee  groups. 

Established  in  1938,  the  council  supports  safe 
and  healthful  working-  conditions  for  employees 
through  medical  supervision  of  workers,  control  of 
environment,  health  education,  and  counseling,  ac- 
cording to  B.  Dixon  Holland,  M.D.,  council  secre- 
tary. The  congress  is  sponsored  each  year  by  the 
American  Medical  Assciation  as  a  means  of  fur- 
thering the  development  and  maintenance  of  high 
medical    standards   in   industry   and   on   the  farm. 

Approved  for  Category  II  credit  for  members  of 
the  American  Academy  of  General  Practice,  the 
program  is  primarily  directed  toward  the  general 
practitioner,  whom,  it  is  estimated,  handles  close 
to  90  per  cent  of  all  the  occupational  medical 
practice  in  the  nation. 

Presiding  over  the  opening  session  of  the  con- 
gress will  be  Dr.  William  P.  Shepard  of  New  York 
City,  chairman  of  the  A.M.A.  Council  on  Occupa- 
tional Health.  The  meeting  will  begin  at  2:00  p.m. 
on  Monday  afternoon  with  Dr.  Amos  N.  Johnson 
of  Garland,  president  of  the  Medical  Society  of  the 
State  of  North  Carolina,  as  the  first  principal 
speaker.  The  sessions  continue  through  Wednesday 
morning,  including  formal  presentations  by  na- 
tionally known  speakers. 

Cooperating  sponsors  include  the  Medical  Society 
of  the  State  of  North  Carolina,  the  Governor's 
Council  on  Occupational  Health,  the  Mecklenburg 
County  Medical  Society,  and  the  Greater  Charlotte 
Occupational  Health  Council. 


North  Carolina  Academy  of 
General  Practice 

The  annual  meeting  of  the  North  Carolina  Acad- 
emy of  General  Practice  will  be  held  at  the  Caro- 
lina  Hotel   in   Pinehurst,   November  27-30. 

The  scientific  sessions  will  be  held  daily  from 
9:00  a.m.  to  12:30  p.m.,  leaving  the  afternoons  free 
for  audiovisual  presentations,  golf,  or  relaxation 
among  friends. 


Fourth  District  Medical  Society 

The  Fourth  District  Medical  Society  will  meet  in 
Wilson  on  September  14  at  6:30  p.m.  Dr.  Franklin 
L.  Angell  of  Roanoke,  Virginia,  will  speak  on  the 
subject  "Premature  Cranial   Synostosis." 


350 


NORTH   CAROLINA  MEDICAL  JOURNAL 


August,  1960 


Edgecombe-Nash  Medical  Society 

The  Edgecombe-Nash  Medical  Society  met  on 
July  13  in  Rocky  Mount. 

Dr.  R.  D.  Komegay,  program  chairman  for  July, 
presented  Dr.  James  Ralph  Dunn,  Jr.,  who  spoke 
on  the   subject  of  vascular  surgery. 


News  Notes 

Dr.  Robert  E.  Nolan  has  announced  the  opening 
of  his  office  at  the  O'Hanlon  Building  in  Winston- 
Salem.  His  practice  will  be  limited  to  general 
surgery. 


Southeastern  Allergy  Association 

The  Southeastern  Allergy  Association  will 
hold  its  annual  meeting  at  the  Atlanta  Biltmore 
Hotel,   Atlanta,   Georgia,    October   21    and  22,    1960. 

Dr.  Susan  Dees,  Duke  Medical  Center,  Durham, 
North  Carolina  is  in  charge  of  the  program.  Every- 
one interested  in  allergy  is   invited  to  attend. 


Southern  Medical  Association 

A  complete  history  of  the  54-year  old  Southern 
Medical  Association  comes  off  the  press  August 
15. 

Its  author  is  C.  P.  Loranz,  Birmingham,  for 
many  years  business  manager  and  secretary-man- 
ager of  Southern  Medical,  now  advisor  and  pro- 
fessional  relations  counselor. 

The  history  details  the  association's  growth 
from  its  beginning  in  1906,  and  includes  statistical 
data  on  officers,  places  of  meeting,  research 
awards  and  membership  figures,  in  addition  to 
numerous   photographs. 


Georgia  Warm  Springs  Foundation 

Preliminary  steps  in  a  projected  program  to 
convert  the  famed  Georgia  Warm  Springs  Founda- 
tion into  a  general  vocational  rehabilitation  center 
serving  the  southeastern  United  States  were  an- 
nounced recently. 

With  the  decline  in  polio  that  has  followed  the 
advent  of  the  Salk  vaccine  five  years  ago,  Warm 
Springs  has  begun  to  utilize  its  vast  rehabilitation 
facilities  to  care  for  physical  handicaps  caused 
by  arthritis,  birth  defects,  spinal  cord  lesions,  cere- 
bral vascular  accidents,  multiple  sclerosis,  and 
other  disabling  neuromuscular  disorders. 


Seminar  on  Kidney  Disease 

The  Southeastern  Region  of  the  College  of 
American  Pathologists  and  the  Virginia  Society  of 
Pathologists  will  hold  a  joint  meeting  at  the  John 
Marshall  Hotel  in  Richmond,  Virginia,  on  Novem- 
ber 25  and  26,  1960,  on  kidney  disease.  The 
speakers  will  include  Drs.  Stanley  M.  Kurtz,  Peter 
P.  Ladewig,  Henry  D.  Mcintosh,  George  Margolis, 
Conrad  L.  Pirani,  David  E.  Smith,  and  Max  Wach- 
stein.  The  slide   seminar  will   be  conducted   by  Drs. 


Paul  Kimmelstiel  and  Solomon  Papper.  The  din- 
ner speaker  will  be  Dr.  Frank  C.  Coleman,  pres- 
ident of  the   College   of   American   Pathologists. 

The  slide  sets  for  this  seminar  on  kidney  disease 
may  be  purchased  at  a  cost  of  $15.00  per  set  by 
writing  to:  Dr.  G.  T.  Mann,  Professor  of  Forensic 
Pathology,  P.  O.  Box  41,  Medical  College  of  Vir- 
ginia, Richmond   19,   Virginia. 


American  Society  for  Clinical  Nutrition 

The  formation  of  a  new  professional  association, 
the  American  Society  for  Clinical  Nutrition,  was 
announced  during  the  meetings  of  the  American 
Society  for  Clinical  Investigation  and  the  Amer- 
ican Federation  for  Clinical  Research  in  Atlantic 
City  recently.  Arrangements  are  being  made  to 
affiliate  the  A. S.C.N,  with  the  American  Institute 
for   Niu-ition. 

Richard  W.  Vilter,  M.D.,  professor  of  medicine 
and  chairman  of  the  department,  University  of 
Cincinnati,  College  of  Medicine,  was  elected  presi- 
dent of  the  A. S.C.N,  by  the  charter  members  at 
the    organization's    first    meeting. 

A  four-point  list  of  objectives  adopted  at  the 
first  meeting  states  that  the  A. S.C.N,  shall: 

1.  Foster  high  standards  for  research  on  human 
nutrition. 

2.  Promote  undergraduate  and  graduate  educa- 
tion in   human   nutrition. 

3.  Provide  a  place  and  opportunity  for  research 
workers  on  problems  of  human  nutrition  to 
present  and  discuss  their  research  activities 
and   results. 

4.  Provide  a  journal  for  the  publication  of  mer- 
itorious  work   on   human  nutrition. 

The  organizing  group  plans  to  adopt  The  Amer- 
ican Journal  of  Clinical  Nutrition  as  its  official 
publication.  The  journal  is  published  by  the  Yorke 
Group,  a  subsidiary  of  the  Reuben  H.  Donnelley 
Corporation. 


AMERICAN    RHINOLOGIC    SOCIETY 

The  American  Rhinologic  Society  will  hold  its 
sixth  annual  meeting  at  the  Belmont  Hotel,  Chi- 
cago, October  8.  Physicians  are  invited;  there  is 
no   registration  fee. 

The  guest  of  honor  and  one  of  the  afternoon 
speakers  will  be  Dr.  Henry  L.  Williams  of  the 
Mayo  Clinic,  Rochester,  Minnesota,  whose  subject 
will  be  "Thirty  Years  of  Experience  in  Rhinology." 
The  dinner  speaker  will  be  Dr.  Morris  Fishbein, 
Chicago,  who  will  speak  on  "Fifty  Years  of  Medical 
Progress." 

A  two-day  surgical  seminar  in  the  Illinois  Ma- 
sonic Hospital,  Chicago,  will  immediately  precede 
the  annual   meeting. 

For  information,  write  Dr.  Robert  M.  Hansen, 
secretary,  American  Rhinologic  Society,  1735 
North   Wheeler  Avenue,   Portland    17,   Oregon. 


August,  1960 


BULLETIN   BOARD 


351 


National  Tuberculosis  Association 

A  potential  danger  in  the  long-term  use  of  ster- 
oid hormones  was  dramatized  in  a  special  exhibit 
prepared  by  the  National  Tuberculosis  Association 
for  the  one  hundred  ninth  annual  meeting  of  the 
American  Medical   Association   in   Miami    Beach. 

On  view  before  the  A.M. A.  members  for  the 
first  time,  the  exhibit,  entitled  "Steroids  Activate 
TB,"  reminded  physicians  that  cortisone  and  re- 
lated drugs  can  activate  unsuspected  latent  tuber- 
culosis. 

The  N.T.A.  exhibit,  winner  of  an.  A.M. A.  Honor- 
able Mention  award,  was  prepared  under  the  di- 
rection of  Dr.  Julius  L.  Wilson  and  Dr.  Floyd  M. 
Feldmann  of  the  American  Thoracic  Society 
(N.T.A.  Medical  Section). 


Fifth  International  Congress 
on  Nutrition 

Nutrition  scientists  from  all  over  the  world  will 
participate  in  the  Fifth  International  Congress  on 
Nutrition  to  be  held  in  Washington,  D.  C,  Sep- 
tember 1-7,  1960.  An  all-day  symposium  on  "World 
Food  Needs  and  Food  Resources''  will  be  one  of 
the  main  features  of  the  scientific  program.  The 
remainder  of  the  program  will  consist  of  seven 
half-day  panel  discussions  by  invited  participants, 
and  special  sessions  of  10-minute  papers  reporting 
unpublished  original  research.  Headquarter  hotels 
will   be  the   Sheraton   Park   and    Shoreham   hotels. 


American  Urological  Association 

The  American  Urological  Association  offers  an 
annual  award  of  $1,000  (first  prize  of  $500,  sec- 
ond prize  $300,  and  third  prize  $200)  for  essays 
on  the  result  of  some  clinical  or  laboratory  re- 
search in  urology.  Competition  is  limited  to  urolo- 
gists who  have  been  graduated  not  more  than  10 
years,  and  to  hospital  interns  and  residents  doing 
research  work  in  urology. 

The  first  prize  essay  will  appear  on  the  program 
of  the  forthcoming  meeting  of  the  American  Uro- 
logical Association,  to  be  held  at  the  Hotel  Bilt- 
more,   Los  Angeles,   California,   May   22-25,    1961. 

For  full  particulars  write  the  Executive  Secre- 
tary, William  P.  Didusch,  1120  North  Charles 
Street,  Baltimore,  Maryland.  Essays  must  be  in 
his   hands  before   December   1,   1960. 


World  Congress  of  Psychiatry 

The  Third  World  Congress  of  Psychiatry,  June 
4-10,  1961,  Montreal,  Canada,  is  being  held  at  the 
invitation  of  McGill  University  and  under  the  aus- 
pices of  the  Canadian  Psychiatric  Association. 
Meeting  on  the  American  Continent  for  the  first 
time,  the  Congress  is  expected  to  attract  some 
3,000  delegates  from  62  nations.  Representatives 
will  come  from  psychiatry  and  such  allied  fields 
as  general  medical  practice,  psychology,  biochem- 
istry, nursing,  sociology,  anthropology,  social  work, 
and   pharmacology. 


Copies  of  the  Second  Announcement,  which  carry 
information  regarding  program  and  registration, 
may  be  obtained  by  writing  the  General  Secretary, 
III  World  Congress  of  Psychiatry.  1025  Pine  Ave- 
nue  West,  Montreal  2,  P.Q.,   Canada. 


World  Medical  Association 

The  Secretary  General  of  The  World  Medical 
Association  announced  that  Dr.  Ernst  Fromm, 
treasurer  of  the  Association,  transmitted  a  check 
for  $1000  to  the  Secretary  of  the  Colegio  Medico  de 
Chile  to  be  used  to  provide  medical  assistance  re- 
lief to  the  earthquake  victims  in  Chile.  Medical 
associations  and  doctors  of  the  world  are  urged  to 
provide  medical  supplies  and  funds  for  the  relief 
of  these  victims.  Assistance  should  be  addressed 
to: 

Dr.   Rolando   Castanon 
Colegio  Medico  de  Chile 
Miraflores   No.   464 
Santiago,   Chile 


u.  s.  department  of 
Health,  Education,  and  Welfare 

Food  and  Drug  Administration 

Stronger  regulations  to  insure  that  physicians 
receive  adequate  information  about  the  drugs  they 
prescribe  and  to  insure  the  safety  of  new  drugs 
have  been  proposed  by  the  Food  and  Drug  Ad- 
ministration. 

The   new  regulations   would: 

(1)  Require  sweeping  changes  in  the  labeling  of 
prescription  drugs.  Virtually  all  prescription  drug 
packages  and  printed  matter  distributed  to  phy- 
sicians to  promote  sale  of  a  drug  would  be  required 
to  bear  complete  information  for  professional  use 
of  the  drug,  including  information  about  any  haz- 
ards, side  effects  or  necessary  precautions.  The 
only  exception  in  the  proposed  regulations  would 
apply  to  frequently  used  medicines  that  are  com- 
monly familiar  to   the   doctor. 

(2)  Provide  that  when  safety  requires,  a  new 
drug  would  be  kept  off  the  market  until  the  man- 
ufacturer's representations  regarding  the  reliabil- 
ity of  manufacturing  methods,  facilities  and  con- 
trols have  been  confirmed  by  a  factory  inspection 
by  the   Food   and   Drug  Administration. 

Other  proposed  labeling  changes  would  require 
drugs  for  injection  and  for  use  in  the  eyes  to  bear 
a  quantitative  declaration  of  all  inactive  ingredi- 
ents. Labels  of  all  prescription  drugs  would  be  re- 
quired to  include  an  "identifying  lot  or  control 
number  from  which  it  is  possible  to  determine  the 
complete    manufacturing    history    of   the    drug." 

Commenting  on  the  proposed  regulations,  George 
P.  Larrick,  Commissioner  of  Food  and  Drugs,  said: 

"The  large  number  of  new  medications  has  made 
it  increasingly  difficult  for  doctors  and  pharmacists 
to  keep  adequately  informed  about  them.  We  are 
hopeful  that  the  proposed  regulations  will  improve 
the    communication    of    vitally    necessary    informa- 


352 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,  I960 


tion  and  bring-  about  a  general  improvement  in 
drug  promotion  practices.  At  the  same  time,  they 
should  furnish  a  basis  for  more  effective  govern- 
ment  control   where    necessary." 

Interested  persons  are  invited  to  submit  written 
comments  on  the  proposed  regulations  to  the 
Hearing  Clerk,  Department  of  Health,  Education 
and  Welfare,  Room  5440,  330  Independence  Ave., 
S.W.,  Washington  25,  D.  C  ,  within  60  days  from 
the   date   of   publication   in    the    Federal    Register. 

Nursing  homes  throughout  the  Nation  report  a 
wide  range  in  daily  operating  costs,  according  to 
a  Public  Health  Service  publication  released  re- 
cently. 

The  booklet,  "Costs  of  Operating  Nursing 
Homes  and  Related  Facilities,"  cites  costs  from 
36  studies  in  nursing  homes,  homes  for  the  aged, 
and  boarding  homes  under  proprietary,  nonprofit, 
and    public    auspices. 

The  report  is  available  from  the  Superintendent 
of  Documents,  U.  S.  Government  Printing  Office, 
Washington  25,  D.   C,  for  20  cents  a  copy. 


Veterans  Administration 

Further  progress  in  establishing  the  cause  and 
treatment  of  cardiac  arrest  (heart  stoppage),  a 
dreaded    complication    of    surgery,    had    been    made 


by  doctors  at  the  Brooklyn,  New  York,  Veterans 
Administration    hospital. 

A  major  factor,  the  research  group  feels,  is 
"potassium  intoxication"  induced  by  massive  blood 
transfusions. 

If  sudden  heart  stoppage  occurs  during  surgery, 
it  is  often  a  lethal  complication  even  though 
massage  of  the  heart  is  instituted  shortly  after  the 
standstill  occurs,  according  to  Dr.  Harry  H.  Le- 
Veen  of  the   Brooklyn   VA   hospital. 

He  and  a  team  of  research  workers  from  this 
hospital  and  the  State  University  of  New  York 
reported  their  findings  in  the  June  18  issue  of  the 
Journal   of   the    American    Medical    Association. 

Their  attention  was  focused  on  blood  transfu- 
sions when  they  noticed  that  cardiac  arrest  oc- 
curred in  several  patients  following  massive  trans- 
fusions. 

A  major  new  instrument  for  atomic  medicine 
has  been  installed  at  the  Veterans  Administration 
center  in   Los  Angeles,   the   VA   announced   recently. 

Known  as  a  human-body  radiation  counting 
system,  the  25-ton  steel  room,  with  instrumenta- 
tion, makes  possible  measurement  of  the  amount 
of  radiation  present  in  the  body  from  fallout,  med- 
ical dosage,  handling  radioactive  materials,  or 
other    sources. 


presenting:  modern,  easy  to  use  aerosol 

PANTHO-FOAM 

hydrocortisone  .  .  .  0.2% 

pantothenylol    ....      2% 

the  dramatic  inflammatory-suppressive,  antipruritic,  antiallergic 
efficacy  of  hydrocortisone 

plus  the  soothing,  antipruritic,  healing  influence  of  pantothenylol 


August,  1960 


BULLETIN  BOARD 


353 


Dr.  William  H.  Blahd,  chief  of  radioisotope 
service  at  the  center,  said  the  counter  will  be  used 
in  diagnosis  and  medical  research  and  will  be  an 
important  resource  for  civil  defense. 

Red  Cross  Gives  Safety  Hints 

Don't  be  a  vital  statistic  this   summer  or  fall. 

This  was  the  Red  Cross  warning  to  the  millions 
of  Americans  who  will  spend  coming  weekends 
taking  to  the  water. 

A.  W.  Cantwell,  National  Director  of  Red  Cross 
Safety  Services,  gave  these  safety  hints  for 
Americans  interested  in  aquatics: 

1.  Learn  to   swim. 

2.  Make  sure  someone  is  near  to  help  you  if 
you  get  in  trouble. 

3.  Swim   in  a  safe   place. 

4.  Know  the   swimming  area. 

5.  Don't  go  beyond  safe  limits  or  your  ability. 

6.  Try  to  stay  calm  in  case  of  trouble. 

7.  Keep  safety  equipment  in  your  boat  or  canoe. 
Non-swimmers  should  wear  life  vests  when  riding 
in  a  small  craft. 

8.  As  a  general  rule  stay  with  your  boat  or 
canoe.  Most  small  craft  will  float,  even  when  filled 
with  water  or   overturned 

9.  Don't   overload  your   boat. 

10.     Don't   "overpower"    your   boat.    A    motor    too 
powerful  for  your  boat  makes  it  difficult  to  control. 


Ten   Rules   for    Cataract   Patients 

Ten  rules  for  persons  who  have  had  cataracts 
removed  from  their  eyes  are  offered  by  a  physician 
who  has  undergone  the  surgery. 

James  M.  Mackintosh,  M.D.,  director  of  educa- 
tion and  training  for  the  World  Health  Organ- 
ization, Geneva,  Switzerland,  outlined  them  in 
Hospitals,  Journal  of  the  American  Hospital  As- 
sociation. 

Dr.    Mackintosh's  rules   are: 

— Leave  your  glasses  where  you  can  find  them 
easily.  This  applies  especially  to  the  bedside  at 
night. 

— Keep  a  spare  pair  of  glasses  in  a  well-marked 
place  known  to  wife,   secretary,   and   self. 

— On  entering  a  room,  survey  the  scene  quickly 
to  detect  hidden  perils  like  footstools,  low  chairs, 
small  children  lying  on  the  floor,  and  other  tripping 
hazards  near  the  ground. 

— Look  around  the  room  to  see  who  is  there  or  you 
may   completely  miss    one    of   its   inhabitants. 

— Before  getting  up,  make  another  quick  survey 
in  case  someone  has  placed  a  drink  on  a  table  below 
your  level  of  vision. 

— -When  walking  and  you  meet  someone  you 
know,  turn  your  head  rapidly  from  right  to  left  to 
make  sure  that  he  is  not  accompanied. 


push-button  control  in 


SklTl  inflammation, 

itching, 
allergy 

PANTHO-FOAM 


supplied:  aerosol 
container  of  2  oz. 


This  non-occlusive  foam  lets  the  skin  "breathe"  as  it 

"puts  out  the  fire"  of  inflammation  —  unlike  ordinary  ointments. 

Applied  directly  on  affected  area,  paniho-Foam  is  today's 
non-traumatizing  way  to  provide  prompt  relief  and  healing  in  .  .  . 

burns 

eczemas  (infantile,  lichenified,  etc.) 
dermatitis  (atopic,  contact,  eczematoid) 

neurodermatitis 
pruritus  ani  et  vulvae 
stasis  dermatitis 


u.s.  vitamin  &  pharmaceutical  corp. 

Arltneton-Fiink  Laboratories,  division  •    250  East  43rd  Street,  New  York  17,  N.  Y. 


354 


NORTH  CAROLINA   MEDICAL  JOURNAL 


August.  1960 


— In  traffic  always  look  several  times  to  left 
and   right  before   crossing. 

— Avoid  occupations  that  require  a  great  deal  of 
bending,  such  as  gardening,  automobile  repairs, 
and    lifting    heavy    articles. 

— Don't  try  to  read  too  long  at  one  time.  A  half- 
hour  spell,  followed  by  a  rest  of  10  minutes,  is 
generally  enough.  The  rest  period  must  not  be  filled 
with  other  eye-straining  activities  such  as  television 
or   sewing. 

— Avoid  contemplating  rapidly  moving  objects, 
such  as  movies  or  swiftly  moving  games,  if  this 
gives  a  sense  of  strain. 

Carbocaine    Called    Big 
Advance    In    Anesthetics 

A  potent  new  local  anesthetic,  described  as  a 
marked  advance  in  its  field  following  extensive 
pharmacologic  and  clinical  studies  over  the  past 
three  years  in  the  United  States,  Sweden,  Den- 
mark, Germany  and  other  countries,  has  been 
made  available  to  the  medical  profession  in  this 
country. 

The  new  anesthetic  agent  is  called  Carbocaine, 
and   is   a  product  of  Winthrop   Laboratories. 

It  has  a  number  of  advantages  as  a  local  anes- 
thetic, chiefly  its  wide  usefulness,  high  potency, 
safety  and  suitability  for  use  without  epinephrine, 
the   vasoconstrictor. 

Carbocaine  has  also  been  found  to  be  extremely 
stable,  enabling  solutions  to  be  autoclaved  re- 
peatedly or  stored  for  long  periods  without  danger 
of  decomposition. 


Classified  Advertisements 

X-RAY  Equipment  for  sale  or  exchange.  100  K.V. 
100  M.A.  Picker  Radiographic  unit  with  manual 
operated  tilt  table  combined  with  Fluoroscope 
unit  beneath  the  table.  Provides  instant  change 
over  from  Fluoroscopy  to  Radiography  with  spot 
film  device.  Has  had  some  use  but  is  in  excellent 
working  order  also  dark  room  equipment,  mag- 
netic type  plate  changer,  Stereoscopic  view  boxes, 
etc.,  will  consider  late  model  Ultra-violet  lamp, 
surgical  endotherm  in  exchange.  Write  Box  790, 
Raleigh,    North    Carolina. 

AVAILABLE  Desirable  twelve  hundred  and  fifty 
square  feet  space  suitable  for  doctors  or  dentist. 
Ground  floor  Cameron  Court  apartments,  corner 
Snow  and  Morgan  Streets,  Raleigh.  Air  con- 
ditioned, also  heat,  lights,  water  and  parking. 
On  long  lease  will  improve  to  suit  tenant.  Apply 
A.   W.   Criddle,  Manager,  Temple  2-5395. 

DESIRABLE  LOCATION  for  a  physician.  Contact 
Godley  Realty  Company,  Mt.  Holly  Road.  Char- 
lotte.  North    Carolina. 

WANTED  Otolaryngologist  and  or  Ophthalmolo- 
gist for  extremely  successful  Asheville  and 
Western  Carolina  practice.  Dr.  Joseph  McGowan 
recently  deceased.  Fully  equipped  office,  exper- 
ienced personnel.  Contact  Mrs.  Joseph  McGowan, 
303    Vanderbilt    Road,    Asheville,    North    Carolina. 


BOOK  REVIEWS 

A   Doctor  in  Many   Lands.   By  Aldo  Castel- 

lani.   319   pages,  plus   30   pages   appendices. 

Price,     $4.95.     Garden     City,     New     York: 

Doubleday  and  Company,  19(50. 
Even  in  the  antibiotic  era  most  physicians  have 
heard  of  Castellani's  mixture  as  a  virtuous  pre- 
paration for  fungal  dermatoses,  but  fewer  medical 
men  know  much  more  about  the  contributions  of 
this  extremely  active  man.  Now  over  80  years  old, 
Dr.  Castellani  has  set  down  anecdotal  reminis- 
cences of  a  lively  career  on  several  continents. 
Born  and  educated  in  Italy,  he  had  further  train- 
ing in  Germany,  then  went  to  England,  casting  his 
fortunes  with  the  Empire  in  Africa  and  Ceylon 
until  the  1914-1918  war.  After  service  with  the 
Italian  Navy,  he  spent  some  time  in  Poland,  then 
resumed  practice  and  teaching  in  London,  Rome 
and  New  Orleans  (at  Tulane  and  Louisiana  State.) 
During  those  years  he  had  a  large  clinical  prac- 
tice in  addition  to  his  laboratory  work,  he  at- 
tended many  famous  people,  furnishing  the  back- 
ground for  amusing  accounts  about  them.  He  was 
very  active  with  the  Italian  military  during  the 
Ethiopian  war.  Still  an  Italian  citizen,  and  this 
time  on  the  side  opposite  his  British  friends,  Cas- 
tellani again  returned  to  Italy  for  the  1939-1945 
war,  seeing  service  in  Europe  and  Africa.  Follow- 
ing the  war  he  went  into  exile  with  the  Italian 
royal  family  and   now  lives   in   Portugal. 

Castellani's  autobiography  does  not  really  tell 
a  great  deal  about  Castellani,  dealing  largely  with 
his  environment  and  his  patients.  As  an  example, 
he  mentions  his  marriage,  his  wife,  and  daughter 
in  two  paragraphs  early  in  the  book,  and  never 
again.  He  is  at  some  pains  to  make  clear  his  con- 
tributions in  the  discovery  of  the  causative  role 
of  trypanosomes  in  African  sleeping  sickness,  and 
various  other  original  observations,  and  deals 
briefly  with  the  circumstances  of  their  discovery. 
One  is  impressed  with  the  unflagging  zeal  and 
curiosity  he  has  brought  to  every  task.  Not  satis- 
fied with  enjoying  the  golden  beauty  spots  so 
piized  by  Singhalese  women  he  took  some  scrap- 
ings from  them  and  found  they  were  fungus  col- 
onies!! Literary  and  poetic  circles  in  Ceylon  did 
not  receive  this  news  enthusiastically,  he  remarks. 
Castellani's  remarks  about  Italian  politicians, 
royalty,  and  military  men  are  especially  interest- 
ing. To  the  end,  Castellani  is  a  royalist,  and  his 
praise  of  royalty  is  unbounded  and  unashamed. 
Many  of  the  famous  Italians  of  this  century  have 
been  his  patients,  and  from  his  long  acquaintance 
he  draws  many  pages  of  remarks.  Mussolini  ap- 
pears as  a  dedicated  and  capable  man  in  his  early 
career,  corrupted  and  ruined  by  the  Germans.  The 
Ethiopian  campaign  is  presented  as  a  sort  of  an 
armed  cultural  and  economic  mission,  which  was 
largely  beneficial  to  the  Ethiopians.  Castellani 
feels  that  the  success  of  the  Italian  campaign  was 
in  large  part  due  to  adequate  medical  preparation 
for  a  tropical   war.   He   later  discusses   the   adverse 


August,  1960 


BOOK   REVIEWS 


355 


effect  of  the  lack  of  adequate  medical  care  in  the 
desert  campaigns  of  the  second  World  War.  The 
appendices  deal  with  "Climate  and  Its  Influence" 
and  "Medical  Aspects  of  the  Ethiopian  Campaign." 
The  book  is  a  pleasant  day's  reading  for  a  sum- 
mer vacation,  and  would  make  an  excellent  gift 
for  anyone  interested  in  an  urbane,  gossipy,  and 
intelligent  physician's  account  of  a  life  well  spent 
and  still   in   progress. 


Rudolph  Matas:  A  Biography  of  One  of 
the  Great  Pioneers  in  Surgery.  By  Isidore 
Cohn,  M.  D.,  with  Hermann  B.  Deutsch. 
431  pages.  Price,  $5.95.  Garden  City,  New 
York:    Doubleday   &    Company,    Inc.,    1960. 

The  subject  of  this  biography  provided  a  wealth 
of  material  for  the  author,  since  Rudolph  Matas 
was  not  only  one  of  the  great  surgeons  of  the 
world,  but  also  a  prolific  writer  of  medical  articles 
and  one  of  the  pioneers  who  crusaded  to  rid  the 
world  of   yellow  fever. 

The  author  has  taken  all  the  skeins  of  Dr. 
Matas'  life  and  woven  them  into  a  splendid  and 
enchanting  story,  one  of  the  threads  being  the  his- 
tory of  the  conquest  of  Bronze  John.  Much  of  the 
political  history  of  New  Orleans  and  Louisiana 
during  the  ninety-seven  years  that  Dr.  Matas 
lived  is   gathered   together  in   this   volume. 

Dr.  Cohn  is  to  be  congratulated  on  his  ability  to 
bring  out  the  true  personality  of  this  great  sur- 
geon and  man.  All  students  of  medicine  and  per- 
sons interested  in  history  and  the  history  of  medi- 
cine will  be  delighted  to  read  this  magnificent 
story. 


New   Teaching    Film    Released   by    SK&F 

"Resuscitation  of  the  Newborn,"  the  first  in  a 
new  series  of  Medical  Teaching  Films  to  be  pro- 
duced semi-annually  by  Smith  Kline  and  French 
Laboratories,  was  released  to  the  medical  pro- 
fession recently. 

Made  under  the  medical  direction  of  the  Special 
Committee  on  Infant  Mortality  of  the  Medical 
Society  of  New  York  County,  the  color  film  illus- 
trates essential  techniques  and  principles  for  the 
resuscitation  of  infants  who  do  not  breathe,  or 
whose   breathing  is   impaired,  at  birth. 

Two  other  educational  films,  produced  before 
the  two-a-year  program  was  begun,  have  been 
incorporated  into  the  SK&F  Teaching  Film  Series. 
They  are  "Recognition  and  Management  of  Re- 
spiratory Acidosis,"  and  "Human  Gastric  Func- 
tion." 

Prints  of  "Resuscitation  of  the  Newborn,"  as 
with  the  other  two  films  in  the  new  series,  may 
be  obtained  on  free  loan  from  Smith  Kline  and 
French  Professional  Service  and  Hospital  Repre- 
sentatives, or  directly  from  the  Smith  Kline  and 
French    Medical    Film    Center,    Philadelphia    1,    Pa. 


The  Month  in  Washington 

Congress  returned  to  work  this  month  to 
take  up  its  unfinished  business,  including 
the  controversial  issue  of  health  care  for 
the  aged,  in  an  atmosphere  dominated  by 
election-year  politics. 

The  three  or  four  week,  tag-end  session 
of  Congress  loomed  as  one  of  the  most  im- 
portant meetings  in  the  past  decade  as  far 
as  possible  impact  on  the  medical  profes- 
sion is  concerned. 

The  lawmakers  are  slated  to  decide 
whether  to  embark  the  federal  government 
on  a  course  that  could  threaten  the  private 
practice  of  medicine,  or  to  adopt  a  volun- 
tary program  that  would  pose  no  such  dan- 
ger. 

The  omnibus  social  security  bill  approved 
by  the  House  Ways  and  Means  Committee 
was  easily  cleared  by  the  House,  381  to  23, 
and  sent  to  the  Senate  Finance  Committee, 
which  held  two  days  of  hearings.  The 
measure  contained  a  voluntary,  federal- 
state  program  for  assisting  needy  aged 
persons  meet  their  health  care  costs.  Both 
the  Administration  and  the  American  Med- 
ical Association  endorsed  the  House  mea- 
sure as  in  keeping  with  the  concept  of  giv- 
ing the  states  prime  responsibility  for 
helping  their  citizens,  for  aiding  those  who 
are  most  in  need  of  help,  and  for  avoiding 
the  compulsory  aspects  of  health  plans  in- 
volving the  social  security  mechanism. 

A  vote  by  the  Finance  Committee,  headed 
by  Senator  Harry  F.  Byrd,  (D.,  Va.)  was 
scheduled  shortly  after  the  Senate  resumed 
operations  in  August.  Whatever  action  the 
Committee  took,  however,  proponents  of 
schemes  such  as  the  Forand  bill  to  provide 
a  compulsory,  federal  medical  program 
promised  a  determined  fight  on  the  floor  of 
the  Senate. 

In  the  event  Congress  should  approve  a 
government  medicine  plan,  opponents  were 
counting  on  a  Presidential  veto  to  kill  the 
measure.  The  Chief  Executive  repeatedly 
has  asserted  in  strong  language  his  all-out 
opposition  to  any  compulsory  plan  for 
health  care  financing. 

At  the  Senate  Finance  Committee  hear- 
ing, Arthur  S.  Flemming,  Secretary  of 
Health,  Education  and  Welfare,  renewed 
the  Administration's  flat  stand  against  the 
social    security   avenue    to    financing    health 


From    the    Washington    Office    of    the    American    Medical    As- 
sociation. 


356 


NORTH   CAROLINA  MEDICAL  JOURNAL 


August,  1960 


costs.  Such  a  plan,  he  said,  would  inevit- 
ably lead  to  pressures  for  expanding  the 
benefits  and  lowering  or  eliminating  the 
age  requirement.  Under  such  circumstances, 
a  15  per  cent  or  20  per  cent  social  security 
payroll  tax  would  not  be  too  far  off,  he  said. 
"We  believe  it  is  unsound  to  assume  that 
revenue  possibilities  from  a  payroll  tax  are 
limitless." 

Dr.  Leonard  W.  Larson,  president-elect 
of  the  American  Medical  Association,  told 
the  Committee  the  House  bill  is  the  "anti- 
thesis of  the  centralized,  socialized,  statist 
approach  of  the  proposals  advocating  na- 
tional compulsory  health  insurance." 

A  spokesman  for  the  insurance  industry 
pointed  out  "giant  strides"  made  by  private 
health  insurance  in  recent  years  in  cover- 
ing aged  persons.  E.  J.  Faulkner  declared 
that  one  of  the  most  prevalent  and  erron- 
eous assumptions  on  the  matter  is  that 
most  of  the  aged  aren't  able  to  contribute 
to  financing  their  own  health  care  costs. 

The  Social  Security  health  bills,  he  said, 
"would  impair  or  destroy  the  private  prac- 
tice of  medicine,  would  add  immeasurably 
to  our  already  crushing  tax  burden,  would 
aggravate  our  severe  public  fiscal  problems, 
and  would  entail  other  undesirable  conse- 
quences." 

In  other  testimony,  the  AFL-CIO  again 
urged  enactment  of  a  Social  Security  health 
bill ;  the  American  Optometric  Association 
and  the  International  Chiropractors  Asso- 
ciation urged  that  health  benefits  included 
in  any  bill  include  the  services  of  osteo- 
paths and  chiropractors,   respectively. 

On  another  legislative  proposal  of  in- 
terest to  the  medical  profession  —  the 
Keogh-Simpson   bill — a   Senate   debate   was 


scheduled  this  month.  Senator  Gordon  Al- 
lott  (R.,  Colo.)  said  in  a  Senate  speech 
that  "I  believe  that  this  legislation  will 
have  the  overwhelming  support  of  this 
body." 

The  bill,  which  would  encourage  retire- 
ment savings  by  the  self-employed  such  as 
lawyers,  small  businessmen  and  physicians 
has  already  been  approved  by  the  House. 
The  Senate  bill,  voted  by  the  Senate  Fi- 
nance Committee,  would  require  participat- 
ing self-employed  to  establish  retirement 
plans  for  their  employees. 


Jin  fiemmiam 

Robert   A.  Matheson,  M.D. 

Dr.  Robert  A.  Matheson  was  born  in  Hoke 
County  on  January  12,  1898.  He  died  at  his  home 
in  Raeford,  on  April  24,  1960. 

He  was  graduated  from  the  University  of  North 
Carolina.  After  studying  medicine  there  for  two 
years  he  enrolled  at  Jefferson  Medical  College 
where  he  was  graduated  in  1926.  He  served  his  in- 
ternship in  Atlantic  City,  New  Jersey,  and  was 
chief  resident  physician  there  for  one  year.  He 
served  in  France  during  World  War  I  and  later 
was  a  major  in  the  North  Carolina  National  Guard. 
He  was  a  member  of  the  Raeford  Methodist 
Church,  the  Raeford  Kiwanis  Club,  and  was  a 
Shriner. 

He  was  a  member  of  the  Hoke  County  Medical 
Society,  the  Medical  Society  of  the  State  of  North 
Carolina,  and  the  Southern  Medical  Association. 
He  practiced  medicine  in  Raeford  from  1928  until 
his  death.  He  was  a  family  doctor  in  every  sense 
of  the  word.  He  not  only  was  friend,  counselor  and 
guide  to  his  many  patients,  but  was  also  highly 
esteemed  by  all  his  colleagues. 


Winston-Salem  • 

•  ••••□      a  Greensboro 

*•  ••         *        • 

•  *      •□  Raleigh 

••        •• 

gAsheville  Washington. 


MATERNAL   DEATHS    REPORTED   IN  NORTH  CAROLINA 
SINCE    JANUARY  I,   I960 

Each   dot  represents  one  death 


August,  1960 


ADVERTISEMENTS 


XXIX 


ALDACTONE 


® 


IN    EDEMA 

Because  it  acts  by  regulating  a  basic  physiologic  imbalance, 
Aldactone  possesses  multiple  therapeutic  advantages  in  treating 
edema. 

Aldactone  inactivates  a  crucial  mechanism  producing  and 
maintaining  edema  —  the  effect  of  excessive  activity  of  the 
potent  salt-retaining  hormone,  aldosterone.  This  corrective  ac- 
tion produces  a  satisfactory  relief  of  edema  even  in  conditions 
wholly  or  partially  refractory  to  other  drugs. 

Also,  Aldactone  acts  in  a  different  manner  and  at  a  different 
site  in  the  renal  tubules  than  other  drugs.  This  difference  in 
action  permits  a  true  synergism  with  mercurial  and  thiazide 
diuretics,  supplementing  and  potentiating  their  beneficial 
effects. 

Further,  Aldactone  minimizes  the  electrolyte  upheaval  often 
caused  by  mercurial  and  thiazide  compounds. 

The  accompanying  graph  shows  a  dramatic  but  by  no  means 
unusual  instance  of  the  effect  of  Aldactone  in  refractory  edema. 

The  usual  adult  dosage  of  Aldactone,  brand  of  spironolactone, 
is  400  rag.  daily.  Complete  dosage  information  is  contained  in 
Searle  New  Product  Brochure  No.  52. 

SUPPLIED:  Aldactone  is  supplied  as  compression-coated 
yellow  tablets  of  100  mg. 

G.D.  SEARLE  &  CO.,    Chicago  80,  Illinois. 
Research  in  the  Service  of  Medicine. 


weight-  lbs      ffirs  i  S ,  Congestive  Heart  Failure 

140- 
130- 
120- 
110- 

f 

1 

40 

A 

Or 

da 
ng 

do 

n 

ne 
4h 

rs. 

\ 

Vs. 

«. 

x 

\ 

\ 

severe  actdo 

sis 

aeetaioleamide 
250  mg./O.O.D. 

V 

\ 

\ 

KCI  3gm./24h.s.                                      [ 

i 

ysine  HCI  30  gm./24 

rs. 

NH.CI    6gm/24hrs.                                                                                             prednisone  10  mg/24  hrs. 

hydrochlorothiazide     100  mg./24  hrs.                                                                                                         *%+ 

maintained  on  digitalis 

l     iTl 

1 

Ng 
1 

1  J  J  III             III                || 

5                    10                  15                   20                   25                  30                   35                   40                  45                   50                  55         58 

(Days  on  Tr eatment]            'patient  discharged. weight  normas 

day':, 

XXX 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,   1960 


August,  1960 


ADVERTISEMENTS 


XXXI 


whenever  digitalis 
is  indicated 


— g 


y 


LANOXIN  DIGOXIN 


formerly  known  as  Digoxin  'B.  W.  &  Co. '" 


Boston,  U«"=  ^^^^^^— 


'LANOXIN'  TABLETS  'LANOXIN'  INJECTION 

0.25  mg.  scored  (white)  0.5  mg.  in  2  cc.  (I.M.  or  I.V.) 

0.5  mg.  scored  ( green ) 


'LANOXIN'  ELIXIR  PEDIATRIC 
0.05  mg.  in  1  cc. 


BURROUGHS  WELLCOME  &  CO.  (U.S.A.)  INC.,  Tuckahoe,  N.Y. 


XXXII 


NORTH  CAROLINA   MEDICAL  JOURNAL 


August,   1960 


WHEN 
THE  PATIE 
WITHO 
ORGANIC  DISEASE 
COMPLAINS 


CONSIDER 


L    NEOCHOLAN' 


Your  patient  will  often  respond  promptly  to  Neocholan  therapy.  It  greatly  increases  the  flow  of 
thin,  nonviscid  bile  and  corrects  biliary  stasis  by  flushing  the  biliary  system.  It  also  relaxes  intesti- 
nal spasm,  resulting  in  an  unimpeded  flow  of  bile  and  pancreatic  juice  into  the  small  intestine. 
Neocholan  helps  to  promote  proper  digestion  and  absorption  of  nutrients.  It  also  encourages 
normal  peristalsis  by  restoring  intestinal  tone. 


Each  tabletprovides:  Dehydrocholic  Acid  Compound, 
P-M  Co.  265  mg.  (Dehydrocholic  Acid.  250  mg.); 
Homatropine  methylbromide  1.2  mg.;  Phenobarbital 
8.0  mg.  Supplied  in  bottles  of  100  tablets. 


MM 


PITMAN-MOORE    COMPANY 

DIVISION   OF  ALLIED    LABORATORIES,  INC. 
INDIANAPOLIS,  INDIANA 


August,  1960 


ADVERTISEMENTS 


XXXIII 


in  all  common  diarrheas 


POMALIN 


LIQUID 


AN  T  I  D  I  AR  R  H  EAL 

with  pleasant  raspberry  flavor 

V  * 

—  eases  and  speeds  the  return 
to  normal  bowel  function  — 

The  comprehensive  antidiarrheal  formula  of  Pomalin  brings  positive  relief  to 
patients  with  specific  and  nonspecific  diarrheas,  bacillary  dysentery,  non- 
specific ulcerative  colitis  and  enteric  disturbances  induced  by  antibiotics. 

Pectin  and  kaolin  protect  against  mechanical  irritation,  adsorb  toxins  and 
bacteria,  and  consolidate  fluid  stools.  Sulfaguanidine  concentrates  antibac- 
terial action  in  the  enteric  tract.  Opium  tincture  suppresses  excessive  peristalsis 
and  reduces  the  defecation  reflex. 

Each  palatable  IS  cc.  ftab/espoon/  contains: 

Sulfaguanidine  U.S. P.  2  Gm. 

Pectin  N.F.  0.225  Gm. 

Kaolin  3  Gm. 

Opium  tincture  U.S. P.  0.08  cc. 

(equivalent  to  2  cc.  of  paregoric) 
Dosage 

ADULTS:  Initially  1  or  2  tablespoons 
from  four  to  six  times  daily,  or  1  or  2 
teaspoons  after  each  loose  bowel  move- 
ment; reduce  dosage  as  diarrhea  sub- 
sides. 


I  lltiitmob 

L  LABORATORIES 

New  York  18,   . 


CHILDREN:  Vi  teaspoon  (2.5  cc.)  per  15 
pounds  of  body  weight  every  four  hours 
day  and  night  until  stools  are  reduced 
to  five  daily,  then  every  eight  hours  for 
three  days. 


HOW    SUPPLIED:    Bottles   of    16   fl.    oz 


Exempt  narcotic. 

Available  on   prescription   only. 


XXXIV 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,   I960 


for  more  normal  living 
in  angina  pectoris 


Brand  of  Penlaerythrltol   Tetranitrate,  30  mg. 


Antora-B 

with   50   mg.  Secobarbital 

/ 


Reduces  incidence  and 
Severity  of  attacks 

Continuous  release  Antora  cap- 
sules give  long,  sustained  therapeutic 
effect  that  reduces  the  number  and 
severity  of  attacks,  lowers  nitro-glyc- 
erin   requirements. 

With  reduced  fear  of  attack  your  pa- 
tient Is  encouraged  to  participate  in 
activities  to  his  allowed   capacity. 


.:..  ?  - 


P^ed&Um 


ANTORA  or  AISTORA-B 

One  continuous  release  capsule 
before  breakfast  and  one  before 
the  evening  meal  provides  24- 
hour  prophylactic   effect. 

Available  in  bottles  of  60  and 
250   capsules. 


Effects  sftlaiion 

without  mvntal  or 

phi/sival  shur  down 


•   A    low   dosage    of 
Secobarbital    is   grad- 
ually  released   with 
Antora   over  a  10-12- 
hour   period   to    reduce 
the   anxiety   complex. 
Antora-B   also   minimizes 
insomnia   due   to    pain 
and    shortness   of 
breath    on    effort. 


Mayrand  m 


e. 


PHARMACEUTICALS 


Greensboro,   North  Carolina 


August,  1960 


ADVERTISEMENTS 


XXXV 


-,;. 


■  -.3- 


'**££%?& 


** 


.  , 


■  i 


. 


; 


for  dryness  and  itching,  prickly  heat  and  rash 
intertrigo,  insect  bites,  other  summer  skin  discomforts 


«M 


in  the 


^bath 


6 


p=o 


^(N? 


SARDO  acts  promptly  to  help  restore  needed 
natural  oil  and  moisture'  to  dry,  itchy  skin,  by 
helping  to  re-establish  the  normal  lipid-aque- 
ous  balance.  Thus  SARDO  eases  irritation, 
soothes,  softens,  brings  sustained  comfort. 

USED  IN  THE  BATH,  SARDO  releases  millions 
of  microfine  water-dispersible  globules*  to  pro- 
vide an  emollient  suspension  which  enhances 
your  other  therapy  ...  in  prickly  heat,  intertrigo, 


insect  bites,  skin  dryness  and  itch  of  atopic  der- 
matitis, eczematoid  dermatitis,  senile  pruritus, 
soap  dermatitis,  etc.' 

Patients  appreciate  pleasant,  convenient,  easy- 
to-use  SARDO.  Non-sensitizing.  Most  economical. 
Bottles  of  4,  8  and  16  oz. 

Write  for  Lompm  and  literature  .  .  . 

IjClT'ClBClU,    ITIC.  New  York  22,  New  York 
e  1959    'Patent  Pending.  T.   M. 


XXXVI 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,  1960 


Sterazolidin 

brand  of  prednisone-phenylbutazone 


Even  in  the  more  transient  rheumatic 
disorders,  an  anti-inflammatory  effect 
more  potent  than  that  provided  by  aspirin 
is  often  desirable  to  hasten  recovery 
and  get  the  patient  back  to  work. 
By  combining  the  anti-inflammatory 
action  of  prednisone  and  phenylbutazone, 
Sterazolidin  brings  about  exceptionally 
rapid  resolution  of  inflammation  with  relief 
of  symptoms  and  restoration  of  function. 
Since  Sterazolidin  is  effective  in  low 
dosage,  the  possibility  of  significant 
hypercortisonism,  even  in  long-term 
therapy,  is  substantially  reduced. 


Availability:  Each  Sterazolidin*  capsule  contains  prednisone 
1.25  mg.;  Butatolidin®,  brand  of  phenylbutazone,  50  mg.; 
dried  aluminum  hydroxide  gel  100  mg.;  magnesium 
trisilicate  150  mg.;  and  homatropine  methylbromlde  1.25  mg. 
Bottles  of  100  capsules. 

Geigy.  Ardsley,  New  York 


Geigy 


August,  1960 


ADVERTISEMENTS 


XXXVII 


Diagnostic 

Quandaries 

Colitis?      Gall  Bladder  Disease? 

Chronic  Appendicitis? 

Rheumatoid  Arthritis  ?      Regional  Enteritis  ? 


I  DISEASE  that  is  frequently 
W  A  V  overlooked  in  solving  diag- 
W  tfk  ^  nostic  quandaries  is  amebiasis. 
MH  Its  symptoms  art'  varied  and 
contradictory,  and  diagnosis  is  extremely 
difficult.  In  one  study,  56%  of  the  cases 
would  have  been  overlooked  if  the  routine 
three  stool  specimens  had  been  relied  on.1 

Another  study  found  96%  of  a  group 
of  150  patients  with  rheumatoid  arthritis 
were  infected  by  E.  histolytica.  In  15  of 
these  subjects,  nine  stool  specimens  were 
required  to  establish  the  diagnosis.2 

Webster  discovered  amebic  infection  in 
147  cases  with  prior  diagnoses  of  spastic 
colon,  psychoneurosis,  gall  bladder  dis- 
ease, nervous  indigestion,  chronic  appen- 
dicitis, and  other  diseases.  Duration  of 
symptoms  varied  from  one  week  to  over 
30  years.  In  some  cases,  it  took  as  many 
as  six  stool  specimens  to  establish  the 
diagnosis  of  amebiasis.3 

Now  treatment  with  Glarubin  provides 
a  means  of  differential  diagnosis  in  sus- 
pected cases  of  amebiasis.  Glarubin,  a 
crystalline  glycoside  obtained  from  the 
fruit  of  Simarouba  glauca,  is  a  safe,  effec- 
tive amebicide.  It  contains  no  arsenic, 
bismuth,  or  iodine.  Its  virtual  freedom 
from  toxicity  makes  it  practical  to  treat 


suspected  cases  without  undertaking  dif- 
ficult, and  frequently  undependable,  stool 
analyses.  Marked  improvement  following 
administration  of  Glarubin  indicates  path- 
ologically significant  amebic  infection. 

Glarubin  is  administered  orally  in  tablet 
form  and  does  not  require  strict  medical 
supervision  or  hospitalization.  Extensive 
clinical  trials  prove  it  highly  effective  in 
intestinal  amebiasis. 


* 


Glarubin 

TABLETS 

specific  for  intestinal  amebiasis 

Supplied  in  bottles  of  40  tablets,  each 
tablet  containing  50  mg.  of  glaucarubin. 

Write  for  descriptive  literature,  bibli- 
ography, and  dosage  schedules. 

1.  Cook,  J.E..  Briegs.  G.W.,  and  Hlndley,  F.W.:  Chronic  Ame- 
biasis and  the  Need  for  a  Diagnostic  Profile,  Am.  Pract.  and  Dig 
ot  Treat.  6:1S21  iDec,  1955). 

2  Rinehart.  R.E..  and  Marcus.  H.:  Incidence  of  Amebiasis  in 
Healthy  Individuals,  Clinic  Patients  and  Those  with  Rheumatoid 
Arthritis.  Northwest  Med..  54:70S  tJuly.  1955). 

3.  "Webster.  B.H.:  Amebiasis,  a  Disease  of  Multiple  Manifesta- 
tions, Am.  Pract.  and  Dig.  or  Treat.  9:S97  (June,  195S). 

•U.S.  Pat.  Ne.  2,864,745 

THES.E.  |V|ASSENGILL   COMPANY 


NEW  YORK 


BRISTOL,  TENNESSEE 
KANSAS  CITY 


SAN  FRANCISCO 


XXXVIII 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,   I960 


•  increases  bile 
Dechotyl  stimulates 
the  flow  of  bile  — 
a  natural  bowel 
regulator 


•  improves  motility 

Dechotyl  gently  stimulates 

intestinal  peristalsis 


•  softens  feces 
"""  Dechotyl  expedites  fluid 
penetration  into  bowel  contents 


helps  free  your  patient  from  both... 
constipation  and  laxatives 

DECHOTYL 

TR  ABLETS' 

well  tolerated... gentle  transition  to  normal  bowel  function 

O  Recommended  to  help  convert  the  patient  — naturally  and  gradually -to  healthy 
bowel  habits.  Regimens  of  one  week  or  more  are  suggested  to  assure  mainte- 
nance of  normal  rhythm  and  to  avoid  the  repetition  of  either  laxative  abuse  or 
constipation. 

Average  adult  dose:  Two  Trablets  at  bedtime  as  needed  or  as  directed  by  a  physician.     ^^^^^"' 
Action  usually  is  gradual,  and  some  patients  may  need  1  or  2  Trablets  3  or  4  times  daily.      AMES 

COMPANY,    INC 

Contraindications:  Biliary  tract  obstruction;  acute  hepatitis.  £"■►"">  ■  i"*«"« 

J  t  Toronto 'Canada 

Dechotyl  Trablets  provide  200  mg.  Decholin,^  (dehydrocholic  acid,  Ames),  50  mg. 
desoxycholic  acid,  and  50  mg.  dioctyl  sodium  sulfosuccinate,  in  each  trapezoid-shaped. 
yellow  Trablet.  Bottles  of  100. 
•Ames  t.m.  for  trapezoid-shaped  tablet.  e<ieo 


August,  1960 


ADVERTISEMENTS 


XXXIX 


How  to  be 
Carefree 
Without 
Hardly 
Trying  •  •  • 


It  really  takes  a  load  off  your  mind.  . . 
to  know  that  you  are  protected  from 
loss  of  income  due  to  illness  or  accident! 

"Dr.  Carefree"  has  no  30-day 
sick  leave  ...  no  Workmen's 
Compensation  . .  .  BUT  he   has  a 
modern  emergency  INCOME  PROTEC- 
TION PLAN  with  Mutual  of  Omaha. 

When  he  is  totally  disabled  by  accident  or  sickness  covered  by  this  plan,  this  plan 
will  give  him  emergency  income,  free  of  Federal  income  tax,  eliminating  the  night- 
mare caused  by  a  long  disability. 

Thousands  of  members  of  the  Medical  Profession  are  protected  with  Mutual  of  Oma- 
ha's PROFESSIONAL  MEN'S  PLAN,  especially  designed  to  meet  the  needs  of  the 
profession. 

If  you  do  not  already  own  a  Mutual  of  Omaha  INCOME  PROTECTION  PLAN,  get  in 
touch  now  with  the  nearest  General  Agent,  listed  below.  You'll  get  full  details,  with- 
out obligation. 


Mutuah 

OF  OMAH 


Largest  Exclusive  Health  and  Accident  Company  in  the  World. 


G.  A.  RICHARDSON,  General  Agent 
Winston-Salem,  N.  C. 


J.  A.  MORAN,  General  Agent 
Wilmington,  N.  C. 


J.  P.  GILES,  General  Agent 
Asheville,  N.  C. 


XL 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,   1960 


1 


•^mJ 


no  irritating  crystals  •  uniform  concentration  in  each  drop 
STERILE  OPHTHALMIC  SOLUTION 

NEO  HYDELTRASOL 


2,000    TIMES    MORE    SOLUBLE    THAN 

"The  solution  of  prednisolone  has  the 

advantage  over  the  suspension  in  that  no 

crystalline  residue  is  left  in  the  patient's 

cul-de-sac  or  in  his  lashes  ....  The  other 

advantage  is  that  the  patient  does  not  have  to 

shake  the  drops  and  is  therefore  sure  of 

receiving  a  consistent  dosage  in  each  drop."2 


PREDNISOLONE  21    PHOSPHATE-NEOMYCIN  SULEATE 

PREDNISOLONE    OR     HYDROCORTISONE 

1.  Lippmann.  0  :  Arch.  Ophth.  57:339.  March  1957. 

2.  Gordon,  DM.:  Am   J.  Ophth.  46:740,  November  1958. 
supplied:  0.5%  Sterile  Ophthalmic  Solution  NEO- 
HYDELTRASOL  (with  neomycin  sulfate)  and  0.5%  Sterile 
Ophthalmic  Solution  HYDELTRASOL'.    In  5  cc.  and  2.5  cc 
dropper  vials.  Also  available  as  0.25%  Ophthalmic 
Ointment  NEO-HYDELTRASOL  (with  neomycin  sulfate) 
and  0.25%  Ophthalmic  Ointment  HYDELTRASOL. 
In  3.5  Gm.  tubes. 


HYDELTRASOL  and  NEO-HYDELTRASOL  are  trademarks  of  Merck  S  Co..  Inc. 
WSW  MERCK  SHARP  &  DOHMf     Division  of  Merck  S  Co.  Inc     Philadelphia  1,  Pa. 


August,  1960 


ADVERTISEMENTS 


XLI 


For  Your  Personal  Pension  Plan 

The  special  features  of  the    New    England    Life 
contract  will  serve  you  to  advantage 

Recently  we  have  run  ads  in  this  Journal  and  pointed  out  the  new  privileges  to  be 
available  to  you  and  other  professional  practitioners  in  the  formation  of  individual 
retirement  programs.  We  described  the  flexible  change  of  plan  clause  in  our  policies, 
and  the  special  techniques  and  contracts  developed  in  connection  with  Corporate 
Pension  Plans,  pointing  out  that  those  fearures  and  services  could  well  be  applicable 
to  you  personally. 

The  experience  and  services  of  our  Company  and  Agency  are  available  to  you  in  con- 
nection with  your  personal  life  insurance  and  retirement  programs,  regardless  of 
and  independent  of  the  Smothers,  Keogh-Simpson  Legislation  that  may  be  passed. 
Any  retirement  program  you  may  now  initiate  through  New  England  Life  can  be 
adapted  through  such  legislation  as  may  be  passed  in  the  future. 

Again  we  list  below  our  Agency  Associates  whose  knowledge  and  experience  may 
serve  you  well. 

AGENCY  ASSOCIATES 


ASHEVILLE 

Henry  E.  Colton,  C.L.U. 

CHARLOTTE 

A.   J.    Beall 
Richard  Cowhig 
Colbert  L.   Dings 
T.   Ed  Thorsen,   C.L.U. 

DURHAM 

R.   Kennon  Taylor,   Jr.,   C.L.U. 

GASTONIA 

Hugh   F.   Bryant 

GREENSBORO 

J.    Meredith   Moore 


HICKORY 

O.   Reid   Lineberger 

HIGH  POINT 

Walter  M.    Bullock 
George   P.  Clark 

RALEIGH 

John  Cates 

Ryland  Duke 

Carlyle  Morris 

Reid  S.  Towler,   C.L.U. 


REIDSVILLE 

James  E.  Everette 

STATESVILLE 

Tom   White 
WILMINGTON 

Meares    Harriss,    L.  L.U. 
Alex   Urquhart,    C.L.U. 

WILSON 

B.   B.   Plyler,  Jr.,   C.L.U. 
WINSTON-SALEM 

Kenneth  W.  Maust 


ARCHIE  CARROLL,  C.L.U.,  GENERAL  AGENT 


NEW  ENGLAND 

C^fe/LIFE±f^fe 


«HI    COMPANY    THAI    PCHJN040    MUTUAb     IU>I    IN|U«*"CI     >"     A M I *  i  CA  - 


612  Wachovia  Bank  Building 


Charlotte,  N.  C. 


XLII 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August. 


SAINT    ALBANS 

PSYCHIATRIC      HOSPITAL 

(A    Non-Profit    Organization) 

Rad&ord,    Virginia 

James  P. 
Daniel  D.  Chiles,  M.  D. 

Clinical  Director 
James  K.  Morrow,  M.  D. 
Silas  R.   Beany,  M.   D. 

STAFF 

<ing,  M.   D.,   Director 

William  D.  Keck,  M.  D. 
Edward  W.  Gamble,  III,  M.  D. 
J.  William  Giesen,  M.  D. 
Internist  (Consultant) 

Clinical  Psychology:                                Don  Phillips 
Thomas  C.  Camp,  Ph.  D.                           Administrator 
Artie  L.  Sturgeon,  Ph.  D. 

AFFILIATED  CLINICS 
Bluefield   Mental   Health   Center                               Beckley  Mental   Health  Center 

525  Bland  St.,  Bluefield,  W.  Va.                       109  E.  Main  Street,  Beckley,  W.  Va. 
David  M.  Wayne,  M.   D.                                            W.  E.  Wilkinson,  M.  D. 
Phone:    DAvenport  5-9159                                         Phone:   CLifford   3-8397 
Charleston  Mental  Health  Center                                 Norton  Mental  Health  Clinic 

1119  Virginia  St.,  E.,  Charleston,  W.  Va.           Norton  Community   Hospital,    Norton,   Va. 
B.   B.  Young,  M.  D.                                                Pierce  D.  Nelson,  M.  D. 
Phone:    Dickens  6-7691                                         Phone:  218,  Ext.  55  and  56 

TUCKER    HOSPITAL,   Inc. 

212  West  Franklin  Street 
Richmond,  Virginia 

A  private  hospital  for  diagnosis  and  treatment  of  psychiatric  and  neurol- 
ogical patients. 
Hospital  and  out-patient  services. 

(Organic  diseases  of  the  nervous  system,  psychoneuroses,  psychosomatic 
disorders,  mood  disturbances,  social  adjustment  problems,  involutional 
reactions  and  selective  psychotic  and  alcoholic  problems.) 


Dk.  James  Asa  Shield 


Dr.  Weir  M.  Tucker 


Dr.  George  S.  Fultz 


Dr.  Amelia  G.  Wood 


August,  1960 


ADVERTISEMENTS 


XLIII 


anorectic-ataractic 


BAMA 


meprobamate  400  mg..  with  d-amphetamine  sulfate  5  mg.,  Tablets 

FOR  THERAPY 
.    OF  OVERWEIGHT  PATIENTS 

■  d-amphetamine  depresses  appetite  and 

elevates  mood 

.  i 

[."-•meprobamate  eases  tensions  of  dieting  ! 

i      (yet  without  overstimulation,  insomnia  or  ' 

barbiturate  hangover). 

I 

Dosage:  One  tablet  one-half  to  one  hour  before  each  meal.      | 

A  LOGICAL  COMBINATION 


APPETITE  CONTROL 


L. ,    --- 


Patronize 


Your 


Advertisers 


**/*¥$ 


AMERICA'S 

AUTHENTIC 

HEALTH   MAGAZINE 


a  good  buy  in 
public  relations 

.  .  .  place 

today's  health 

in  your  reception  room 

Give  your  order  to  a  member  of  your  local  Medical 
Auxiliary  or  mail  it  to  the  Chicago  office. 


SPECIAL 

HALF-PRICE  RATES  FOR 

PHYSICIANS, 

MEDICAL  STUDENTS.  INTERNS 


TODAY'S    HEALTH 

PUBLISHED   MONTHLY   BY  THE 
AMERICAN   MEDICAL  ASSOCIATION 
535   NORTH    DEARBORN  •  CHICAGO   IO 

Please  enter   □,  or   renew   □,   my  subscription  for  the 
period  checked  below : 


STREET- 
CITY 


CREDIT  WOMAN'S   AUXILIARY  OF 


D4  YEARS  ...  sVp^  S4.00         Q  2   YEARS  .  .  .Vsj2fO  S2.SO 
□  3  YEARS.  .  .  S^TSiO   S3. 25         D  1    YEAR «SOO  SI. SO 


XLIV 


NORTH   CAROLINA  MEDICAL  JOURNAL 


August,    19(30 


HIGHLAND   HOSPITAL,   INC. 

Founded  In  1904 

ASHEVILLE,  NORTH   CAROLINA 

Affiliated  with  Duke  University 


A    non-profit   psychiatric    institution,    offering    modern    diagnostic    and    treatment    procedures — insulin,    electroshock,    psy- 
chotherapy,   occupational    and    recreational    therapy — for    nervous    and    mental    disorders. 

The  Hospital   is   located   in   a   75-acre   park,   amid    the  scenic   beauties  of  the  Smoky  Mountain    Range  of   Western    North 
Carolina,   affording   exceptional    opportunity   for   physical    and    emotional    rehabilitation. 

The    OUT-PATIENT    CLINIC    offers    diagnostic    service    and    therapeutic    treatment     for    selected     case     desiring     non- 
resident   care. 

R.  CHARMAN  CARROLL,  M.D.        ROBERT    L.    CRAIG,    M.D.        JOHN    D.    PATTON,    M.D. 
Medical   Director  Associate    Medical    Director  Clinical   Director 


Compliments  of 

WachtePs,  Inc* 

SURGICAL 
SUPPLIES 


65  Haywood  Street 
ASHEVILLE,  North  Carolina 

P.  O.  Box   1716      Telephone  3-7616—3-7617 


p 

^logical 
-combination 
I  for  appetite 
|  suppression 


s  meprobamate  plus 

i  d-amphetamine... suppresses 


appetite. 


elevates  mood.. 
without 


%  reduces  tension 
t       v -;  insomnia,  overstimulation 
*~    Je  or  barbiturate  hangover. 

anorectic-ataractic 
Dosage:  One  tablet  one-half  to  one  hour  before  each  meal. 


August,  1960 


ADVERTISEMENTS 


XLV 


APPALACHIAN     HALL 

ESTABLISHED  —  1916 


ASHEVILLE 


NORTH  CAROLINA 


An    Institution    for   the    diagnosis    and   treatment    of    Psychiatric    and  Neurological    illnesses,    rest,    convalescence,    drucr 

and  alcohol  habituation. 

Insulin     Coma,     Electroshock     and     Psychotherapy     are    employed.    The  Institution    is    equipped    with    complete   laboratory 

facilities    including     electroencephalography     and     X-ray. 

Appalachian     Hall    is    located    in    Asheville,    North    Carolina,    a    resort  town,    wnich    justly    claims    an    all    around    climate 

for    health    and    comfort.    There    are    ample    facilities    for    classification  of    patients,    rooms    single    or    en   suite. 


Wm.  Ray  Griffin,  Jr.,  M.D. 
Robert  A.  Griffin,  M.D. 


Mark  A.  Griffin,  Sr.,  M.D. 
Mark  A.  Griffin,  Jr.,  M.D. 


For  rates  and  further  information  write       APPALACHIAN    HALL,    ASHEVILLE,    N.    C. 


BRAWNER'S  SANITARIUM,  INC, 

(Established  1910) 
2932  South  Atlanta  Road,  Smyrna,  Georgia 


FOR   THE   TREATMENT   OF   PSYCHIATRIC    ILLNESSES 
AND   PROBLEMS  OF  ADDICTION 

MODERN      FACI  LITI  ES 

Approved  by  Central  Inspection  Board  of  American  Psychiatric  Association 
and  the  Joint  Committee  on  Accreditation 

Jas.  N.  Brawner,  Jr.,  M.D. 
Medical  Director 

Phone   H  Em  lock  5-4486 


How  to  Turn  a  *5M  Raise 
into  a  ^1,000  Bonus 


Wishing  won't  turn  a  $5  a  week 
raise  into  a  $1,000  bonus,  but  it's 
easy  to  do.  If  you  take  that  $5 
raise  and  put  it  into  U.  S.  Savings 
Bonds  you  can  buy  a  $25.00  Bond 
a  month  (cost  $18.75)  and  have 
money  left  over.  If  you  keep  buy- 
ing one  of  these  Bonds  a  month 
for  40  months  you'll  have  your 


big  bonus— Bonds  worth  $1,000 
at  maturity. 

It's  a  pretty  smart  idea  to  save 
a  raise.  It's  money  you  didn't 
have  before  and  shouldn't  miss. 
But,  whether  you've  just  gotten  a 
raise,  or  not,  why  don't  you  ask 
your  employer  to  include  you  in 
the  Payroll  Savings  Plan? 


Why  U.S.  Savings  Bonds  are  such 
good  way  to  save. 

•  You  can  save  automatically  wi 
the  Payroll  Savings  Plan  •  Y< 
now  earn  3:!4'c  interest  to  m 
turity  •  You  invest  without  ri 
under  U.  S.  Government  guara 
tee  •  Your  money  can't  be  lo 
or  stolen  •  You  can  get  yo 
money,  with  interest,  anytime  yi 
want  it  •  You  save  more  thi 
money;  you  help  your  Governme 
pay  for  peace  •  You  can  bi 
Bonds  where  you  work  or  ban 


EVEN  IF  YOUR 

BONDS  ARE 

DESTROYED.  YOUR 

MONEY  IS  SAFE. 

Your  Bonds 
are  recorded 
in  your  name 
at  the  Treas- 
ury. If  any- 
thing happens  to  them  the  Gov- 
ernment replaces  them  free. 


YOU  SAVE  MORE  THAN  MONEY.  You  help  save 
the  things  worth  living  for.  Every  Bond 
dollar  helps  keep  America  strong  to  pre- 
serve the  peace. 


Every  Savings  Bond  you  own  — old 
or  new — earns  ^  %  more  than  ever 
before  when  held  to  maturity. 


You  Save  More 
Than  Money  With 
U.S.  Savings  Bonds 


WHAT  SHOULD  HE  DO  WITH  AN  EXTRA  S5  A  WEEK?  He  can  spend  it,  of 
course.  But,  if  he  buys  a  $25.00  U.  S.  Savings  Bond  each 
month  for  40  months  with  his  $5  a  week  raise,  he  is  going 
to  have  Bonds  worth  $1,000. 


The  U.  S,  Government  does  not  pay  for  this 
advertising.  The  Treasury  Department  thanks 
The  Advertising  Council  and  this  magazine 
for  their  patriotic  donation. 


August,  1960 


ADVERTISEMENTS 


XLVII 


r  1 

A  ! 

logical 

prescription  for 

overweight  patients 


anorectic-ataractic 


■  m  m  m    I 

j    meprobamate  400  mg.,  with  d-amphetamine  sulfate  5  mg.,  Tablets 
i 

meprobamate  plus  d-amphetamine... 
depresses  appetite... elevates  mood... 
eases  tensions  ot  dieting. ..without  over- 
stimulation, insomnia  or  barbiturate 

hangover. 
\ 

Dosage:  One  tablet  one-half  to  one  hour  before  each  meal. 


Come  to  Mr.  Pisgah  and  be  tranquillized 
by  nature.  Rustic  inn  &  cottages  perched 
high  on  slope  in  National  Forest  near 
Asheville.  Heavenly  quiet.  Cool.  Over- 
looks glorious  Great  South  View.  Exhil- 
arating air,  superb  food.  Refuge  and 
restorative  for  tired  doctors.  May  1-Oct. 
31. 


Write 

PISGAH  FOREST  INN 

Candler,   N.  C.   Rr.    1,   Box   433 


Posture 


is  A  PLUS 


YOU  CAN  GET  FROM  SLEEPING... 
THAT'S  WHY  IT'S  WISE  TO  SLEEP  ON  A 

Sealq 

POSTUREPEDIC 


Uniformly  firm, 
Sealy  Posturepedic 
keeps  the  spine 
level.  Healthfully 
comfortable,  it  per- 
mits proper  relaxa- 
tion of  musculatory 
system  and  limbs. 
Exclusive  "live-ac- 
tion" coils  support 
curved,  fleshy  con- 
tours of  the  body, 
assuring  relaxing 
rest  that  you  know 
is  basic  to  good 
health  . . .  and  good 
posture. 


A  Sagging 
Mattress  Can 
Cause  This) 


PROFESSIONAL 

DISCOUNT 
OF 


$39 


00 


Limit  of  one  full  or 
two  twin  size  sets 

Please  check  preference 


So  that  you  as  a  physician  can 
judge  the  distinctive  features  of  the 
Sealy  Posturepedic  mattress  for 
yourself  before  you  recommend  it 
to  your  patients,  Sealy  offers  a  spe- 
cial Doctor's  Discount  on  this  mat- 
tress and  foundation,  when  pur- 
chased for  your  personal  use. 


SEALY   MATTRESS   COMPANY 

666  Lake  Shore  Drive,  Chicago  1  1 ,  Illinois 
RETAIL 
Posturepedic  Mattress        each  $79.50 


Posturepedic  Foundation    each  $79.50 

TTull    size   (      )    1    Twin    size    (      )    2 
Enclosed  is  my  check  and  letterhead. 
Please  send  my  Sealy  Posturepedic  Set(s)  to. 


PROFESSIONAL 

add5ratel   $°0.00 
,ax  (  $60.00 

Twin   size  {     ) 


ADDRESS. 

~ity 


_ZONE_ 


XLVIII 


NORTH   CAROLINA   MEDICAL  JOURNAL 


August,   I960 


miialis 

in  its  completeness 


irarroi' 
Digitalis 

I  D*  v  \r  a      Ren-  I 

O.l  Gram 

aipiox.  I1-.  8r»inst 
CAUTIQKi  FvdereJ 
law  prohibit*  dispens- 
ing without  pr«**(*rip- 
tion 


Each  pill  is 

equivalent  to 

one  USP  Digitalis  Unit 

Physiologically  Standardized 

therefore  always 

dependable. 


Clinical  samples  sent  to 
physicians  upon  request. 


Da  vies,  Rose  &  Co.,  Ltd. 
Boston,  18,  Mass. 


*!  Convalescence 


a 


Adolescence 


Infant  diarrhe^ 


Debilitating 

gastrointestinal 

conditio! 


Old  age 


Whenever 
the  diet  is  faulty, 
the  appetite  poor, 
or  the  loss  of  food 
is  excessive 

through  vomiting 
or  diarrhea — 

Valentine's 

MEAT  EXTRACT 


stimulates  the  appetite, 

increases  the  flow  of 
digestive  juices, 

provides:  supplementary 
amounts  of  vitamins,  minerals 
and  soluble  proteins, 

extra-dietary  vitamin  Bu, 

protective  quantities  of 
potassium,  in  a  palatable  and 
readily  assimilated  form. 


•  Postoperatively 


Supplied  in  bottles  oj  2  or  6  jluidounces. 

Dosage  is  1  teaspoonjul  two  or  three  times 
daily;  two  or  three  times  this  amount  for 
potassium  therapy. 

VALENTINE  Company,  Inc. 

RICHMOND  21,  VIRGINIA 


August,  1960 


ADVERTISEMENTS 


MUX 


Westbrook.  Sanatorium   ]— , 


RICHMOND 


€stablisheJ  iQlL 


VIRGINIA 


A.  private  psychiatric  hospital  em- 
ploying modern  diagnostic  and  treat- 
ment procedures — electro  shock,  in- 
sulin, psychotherapy,  occupational 
and  recreational  therapy — for  nervous 
and  mental  disorders  and  problems  of 
addiction. 


Staff  Pu  '-  v-   ANDERSON,  M.D.,  President 

REX  BLANKINSHIP,  M.D.,  Medical  Director 

JOHN  R.  SAUNDERS,  M.D.,  Assistant 
Medical  Director 

THOMAS  F.  COATES,  M.D.,  Associate 

JAMES  K.  HALL,  JR.,  M.D.,  Associate 

CHARLES  A.  PEACHEE,  JR.,  M.S.,  Clinical 
Psychologist 

R.  H.  CRYTZER,  Administrator 


Brochure  of  Literature  and  Views  Sent  On  Request  -  P.  O.  Box  1514  •  Phone  5-3245 


Protection  Against  Loss  of  Income 
from  Accident  &  Sickness  as  Well  as 
Hospital  Expense  Benefits  for  You  and 
All  Your  Eligible  Dependents 


All 


PREMIUMS 


COME  FIOM 


PHYSICIANS 
SURGEONS 
DENTISTS 


All 


BENEFITS 


GO  TO 


PHYSICIANS    CASUALTY    &    HEALTH 
ASSOCIATIONS 

OMAHA  31,   NEBRASKA 
Since      1902 

Jandsome  Professional  Appointment  Book  sent   to 
yon    FREE   upon  request. 


F "  •      ■  : 

i  A  LOGICAL  ADJUNCT  TO  THE  | 
WEIGHT-REDUCING  REGIMEN 


meprobamate   plus  d-amphetamine . . . 

reduces  appetite. ..elevates  mood. ..eases 

tensions  of  dieting,.. without  overstimula-  j 

i  tion,  insomnia  or  barbiturate  hangover. 
I  I 

Dosage:  One  tablet  one-half  to  one  hour  before  each  meal.  . 


anorectic-ataractic 


NORTH  CAROLINA  MEDICAL  JOURNAL 


August,   1960 


THIS 


Doctor 


IS  the  SYMBOL  0F  ASSURANCE  OF  ETHICAL 
public  relations  minded  handling  of  your  accounts 
receivable  and  collection  problems. 


IS    ,he    EMBLEM   of   sound   experience    in    SERVICE 
to  the  professional  offices. 

IS   ,he     MARK      of     a      complete      PROFESSIONAL 
accounts    receivable   service. 


Here  Are  the  BUREAUS  in  Your  Area  Capable  and   Ready  to   Serve  You 


MEDICAL-DENTAL    CREDIT    BUREAU 
514    Nissen    Building 
P.  O.  Box  3136 
Winston-Salem,    N.    C. 
Phone    PArk  4-8373 

MEDICAL-DENTAL  CREDIT   BUREAU 
715    Odd    Fellows   Building 
Raleigh,   N.   C. 
Phone  TEmple   2-2066 

MEDICAL-DENTAL   CREDIT   BUREAU 
513   Security    Bank   Building 
High    Point,    N.    C. 
Phone   3955 

MEDICAL-DENTAL  CREDIT   BUREAU 
A  division   of  Carolina    Business  Services 
Room    10    Masonic   Temple    Building 
P.  O.  Box  924 
Wilmington,   N.   C. 
Phone  ROger  3-5191 


MEDICAL-DENTAL  CREDIT   BUREAU 
212   West   Gaston    Street 
Greensboro,    N.    C. 
Phone    BRoadway   3-8255 

MEDICAL-DENTAL   CREDIT    BUREAU 
220   East   5th    Street 
Lumberton,    N.    C. 
Phone   REdfield    9-3283 

MEDICAL-DENTAL    CREDIT    BUREAU, 

225   Hawthorne  Lane 

Hawthorne    Medical    Center 

Charlotte,  N.   C. 

Phone    FRanklin   7-1527 

THE    MEDICAL-DENTAL    CREDIT    BUREAU 
Westgate  Regional  Shopping  Center 
Post  Office  Box  2868 
Asheville,    North    Carolina 
Phone    ALpine   3-7378 


INC. 


j  B 

BBtSVi 

II  ... 

.      .1. 

" 

:"**•? 

I 

« 

0 

L  -  ' 


i 


fi 


For  Prevention  and  Reversal  of 

Cardiac  Arrest 

The  Birtcher  Mobile  Cardiac  Monitoring  and  Re- 
suscitation Center* 
\ 

Cardiac  Arrest  is  an  ever  present  danger  during 
anesthesia 

Cardiac  arrest  can  occur  during  an  anesthesia,  even  to 
patients  with  no  prior  record  of  cardiac  disease.  Contin- 
uous monitoring  of  every  patient  can  prevent  most 
cardiac  arrests  by  providing  advance  warning.  For  cases 
where  the  accident  cannot  be  prevented,  instruments  to 
reverse  the  arrest  and  restore  circulation  should  always 
be  instantly  available. 

'Comprised  of  the  Birtcher  Cardioscope,  EEG  Pre-Amplifier,  Dual 
Trace  Electronic  Switch.  Electrocardiograph.  Defibrillator  and  Heart- 
pacer    with    all    necessary    attachments    on    a    Mobile    Stand    as   shown. 

Carolina  Surgical  Supply  Company 

r  m  "The    House    of    Friendly    and    Dependable    Service" 

~         706    TUCKER   ST.  TEL:    TEMPLE    3-8631 

4~~7  RALEIGH.    NORTH    CAROLINA 


August,  1960 


ADVERTISEMENTS 


LI 


INDEX  TO  ADVERTISERS 


American    Casualty   Insurance    Company   XIX 

Ames  Company  XXXVIII 

Appalachian   Hall   XLV 

Arnar-Stone   Laboratories   XIII 

Brawner's  Sanitarium   XLV 

Brayten   Pharmaceutical   Company   XV 

Bristol   Laboratories  XVIII,  XXI 

Burroughs-Wellcome    &    Company    XXXI 

Carolina  Surgical   Supply  Co L 

Columbus   Pharmacal   Company   XXX 

J.  L.  Crumpton  XXVIII 

Davies,  Rose  &  Co XLVIII 

Geigy  Pharmaceutical  XXXVI 

Highland    Hospital    XLIV 

Hospital  Saving  Assn.  of  N.  C XXV 

Jones   and    Vaughan,    Inc Ill 

Lederle   Laboratories   XXVI,    XXVII,   XLIII, 

XLIV,  XLVII,  XLIX 
Eli  Lilly  &  Company  XXVII,  Front  Cover 

The  S.  E.  Massengill   Company  XXXVII 

Mayrand,    Inc XXXIV 

Medical-Dental    Credit    Bureau    L 

Merck,   Sharp  &  Dohme   Second  Cover,  XL 

Mutual   of  Omaha  XXXIX 

New  England   Mutual   Life   Insurance  Co XLI 

Parke,  Davis  &  Co LII,  Third  Cover 


Physicians  Casualty  Association 

Physicians    Health    Association   XLIX 

Physicians    Products    Company    XII 

Pinebluff   Sanitarium    I 

Pisgah  Forest  Inn  XLVII 

Pitman-Moore   Company   XXXII 

P.  Lorillard   Company    (Kent  Cigarettes)    XI 

A.  H.  Robins  Company  X,  XXIII 

J.  B.  Roerig  &  Company  XXII 

Saint   Albans    Sanatorium    XLII 

Sardeau,   Inc XXXV 

W.   B.    Saunders   Company   VII 

Sealy  of  the  Carolinas,  Inc XLVII 

G.  D.  Searle  &  Co XXIX 

Smith-Kline  &   French   Laboratories   4th   Cover 

E.  R.  Squibbs  and   Sons  XIV,  XX 

St.  Paul  Fire  and   Marine   Insurance   LI 

Tucker   Hospital   XLII 

U.  S.  Vitamin  Company  Reading- 
Valentine  Company  XLVIII 

Wachtel's   Incorporated    XLIV 

Wallace  Laboratories   XVI,  Insert,   XVII 

Wesson  Oil  and  Snowdrift 

Sales   Company   IV,   V 

Westbrook    Sanitorrum     XLIX 

Winchester  Surgical  Supply  Co. 

Winchester-Riteh    Co I 

Winthrop  Laboratories VI,  Insert,  IX,  XXXIII 


•Ury 


CHOSEN    BY  MEDICAL 
SOCIETY  OF  THE   STATE  OF 
NORTH    CAROLINA    FOR 
PROFESSIONAL 
LIABILITY   INSURANCE 


for  your  complete  insurance  needs  . . . 

^PROFESSIONAL 
*  PERSONAL 
ik  PROPERTY 


THERE  IS  A  SAINT  PAUL  AGENT  IN  YOUR 
COMMUNITY  AS  CLOSE  AS  YOUR  PHONE 


Head  Office 
412    Addison    Building 
Charlotte,    North    Carolina 
EDison   2-1633 


HOME    OFFICE:    385    WASHINGTON    ST.,  ST.   PAUL,  MINN. 


SERVICE   OFFICE:    RALEIGH,   NORTH    CAROLINA— 323    W.    MORGAN    ST.    TEmple   4-7458 


allergen  in  the  wind 


when  pollens  harry  the  unwary 


antihistaminic-antispasmodic 


gives  prompt,  comprehensive  relief 

In  hay  fever,  BENADRYL  provides  simultaneous, 
dual  control  of  allergic  symptoms.  Nasal  congestion, 
lacrimation,  sneezing,  and  related  histamine  reac- 
tions are  effectively  relieved  by  the  antihistaminic 
action  of  BENADRYL.  At  the  same  time,  its  anti- 
spasmodic effect  alleviates  bronchial  and  gastro- 
intestinal spasms.  This  duality  of  action  makes 
BENADRYL  valuable  throughout  a  wide  range  of 
allergic  disorders. 

BENADRYL  Hydrochloride  (diphenhydramine  hydrochloride, 
Parke-Davis)  is  available  in  a  variety  of  forms  including:  Kap- 
seals,®'  50  mg.  each;  Kapseals,  50  mg„  with  ephedrine  sulfate, 
25  mg.;  Capsules,  25  mg.  each;  Elixir,  10  mg.  per  4  cc.;  and  for 
delayed  action,  Emplets,®  50  mg.  each.  For  parenteral  therapy, 
Benadryl  Hydrochloride  Steri-Vials,®  10  mg.  per  cc;  and  Am- 
poules, 50  mg.  per  cc. 


PARKE-DAVIS 


PARKE,  DAVIS  &  COMPANY-  DETROIT  32,  MICHIGAN 


in  overweight 


« 


DE 


A 


brand  of  dextro  amphetam'ne  and  amobarbital 


brand  of  sustained  release  capsules 


® 


[— r:® 

j     ~! 


SMITH 
KLINEOf 
FRENCH 


for  the  patient  who  is  tense, 
irritable,  frustrated  by  inability 
to  stick  to  diet 


. . .  and  for  the  patient  who  is  listless, 
lethargic,  depressed  by  reducing  regimens: 

R  DEXEDRINE*     SPANSULE® 

brand  of  dextro  amphetamine  brand  ot  sustained  release  capsules 

sulfate 

Each  'Dexamyl'  Spansule  sustained  release  capsule  (No.  2)  contains  'Dexedrlne'  (brand  of 
dextro  amphetamine  sulfate),  15  mg.,  and  amobarbital,  1VS  gr.  Each  'Dexamyl'  Spansule  cap- 
sule (No.  1)  contains  'Dexedrine',  10  mg.,  and  amobarbital,  1   gr. 

Each  'Dexedrine'  Spansule  sustained  release  capsule  contains  dextro  amphetamine  sulfate, 
5  mg.,  10  mg.,  or  15  mg. 


NORTH  CAROLINA 


RECEIVED 

OCCUPATIONAL    HEALTH    ISSUE  ,on 

OCT    3  60 

Congress  on  Industrial  Health  —  Charlotte,  October  10-12 

DIVISION  OF 

Jcc&iRS  LIBRARY- 
HEALTH  AFFAIRS  lid 


.; 


when  judgment  dictates  oral  penicillin,  experience  dictates. 


V-CILLIN  K 


(penicillin  V  potassium,  Lilly) 


'  for  maximum  effectiveness 
for  unmatched  speed 
for  unsurpassed  safety 

In  tablets  of  125  and  250  mg. 

ELI    LILLY  AND   COMPANY    •    INDIANAPOLIS   6,   INDIANA,   U.S.A. 


® 


Sfay 

033230 

Table  of  Contents,  Page  II 


LINICAL  REMISSION 

I A  "PROBLEM"  ARTHRITIC 

heumatoid  arthritis  with  jerious_corticoid  side  effects.  Follow.ng 
ound  weight  loss  and  acute  g.i.  distress  on  prednisolone,  a  45-year- 
bookkeeper  with  a  five-year  history  of  severe  arthritis  was  started 
)ecadron,  1  mg./day.  Dosage  was  promptly  reduced  to  0.5  mg./day. 
,r  ten  months  on  Decadron,  she  gained  back  eleven  pounds,  feels 
1  well,  and  had  no  recurrence  of  stomach  symptoms.  She  is  in 
ical  remission.* 

convenient  b.i.d.  aUernate  dosage  schedule:  ,he  degree  and  extent  of  relief  provided  b» 
IDRON  atiows  tor  b.i.d.  maintenance  dosage  in  man,  patients  with  so-called  chrome .cor ,  ,- 
,  Acute  manifestations  sbou.d  first  be  brought  under  contro!  w,th  a  t.,.d.  or  q.i.d.  schedule, 
rttod-  As  0  75  mg.  and  0.5  mg.  scored,  pentagon-shaped  tablets  in  bottles  of  100.  Also  available 
Action  DECADRON  Phosphate.  Addition,  information  on  DECADRON  is  available  t.  phys.c.ans 
equest.  DECADRON  is  a  trademark  of  Merck  &  Co..  Inc. 
„  a  clinical  investigator's  report  to  Merck  Sharp  &  Dohme. 

lecadron 

REflfS  MORE  PATIENTS  MORE  EFFECTIVELY 

TM     MERCK  SHARP  &  DOHME  •  Division  of  Merck  &  Co.,  Inc.,  West  Point,  Pa. 


September,  1960 


ADVERTISEMENTS 


A   Sanitarium  for   Rest    Under  Medical   Supervision,  and   Treatment  of   Nervous 
and  Mental  Diseases,  Alcoholism  and  Drug   Addiction. 

The  Pineulutf  sanitarium  is  situated  in  the  sandhills  of  North  Carolina  in  a  60-acre  park 
uf  long  pines.  It  is  located  on  U.  S.  Route  1,  six  miles  south  of  Pinehurst  and  Southern 
Pines.    This    section    is    unexcelled    for    its    healthful    climate. 

Ample  facilities  are  afforded  for  recreational  and  occupational  therapy,  particularly  out- 
of-doors. 

special  stress  is  laid  on  psychotherapy.  An  effort  is  made  to  help  the  patient  arrive  at 
an  understanding  of  his  problems  and  by  adjustment  to  his  personality  difficulties  or 
modification  of  personality  traits  to  effect  a  cure  or  improvement  in  the  disease.  Two  resident 
physicians    and    a    limited    number    of    patients    afford    individual    treatment    in    each    case. 

Kor    further    information     write: 

The  Pineblu££  Sanitarium,  PinebiuSS,  N.  c. 


iMalcolm   D.  Kemp,  M.D. 


Medical  Director 


ITTER***  the  finest  for 

the  profession! 


Just  a  FEW  of  the  Outstanding  Features 


THE  RITTER  UNIVERSAL  TABLE  enables 
you  to  treat  more  patients  more  thoroughly, 
with  less  effort  in  less  time.  Here  is  the  ulti- 
mate in  examining  table  flexibility  .  .  .  easy 
to  position  .  .  .  more  comfortable  for  patients. 


•  Grey   vinyl   upholstery,  fabric   backed. 

•  Perineal    cut-out   and    stainless    irrigating    pan. 

•  Retractable,  adjustable  heel  stirrups. 

•  Combination  proctologic  kneerest,  footrest  and 
table  extention. 

•  Maximum    Trendelenburg    42°,    Maximum 
Reverse  Trendelenburg   15°. 

•  Full   18"  elevation  from  low  of  26'  2"  to  high 

of  44  y2". 

•  Effortless  hand  wheel  tilt. 

•  Motor  base  has  foot  pedal  elevating  and  lowering 
controls  accesible   from   either  side  of  table. 

0    Silver  metallic  finish 

•  Base    permits    180°    table    rotation;    foot    lever    rotation 
lock. 

•  Stationary  base  plate,  black  enamel  finish. 

Authorized   agents  for,   RITTER,    LIEBEL-FLARSHEIM  and  CASTLE 


WINCHESTER 


"CAHOLINAS'    HOUSE    OF    SERVICE" 

WINCHESTER   SURGIICAL   SUPPLY   CO.  WINCHESTER-RITCH    SURGICAL   CO. 

421  West  Smith  St.       Greensboro,  N.  C. 


119   East  7th  Street 


Charlotte,  N.   C. 


II 


NORTH   CAROLINA   MEDICAL  JOURNAL 


September.  I960 


North  Carolina  Medical  Journal 

Official  Organ  of 
The  Medical  Society  of  the  State  of  North  Carolina 


Volume  21 

Number   9 


September,  1960 


76    CENTS    A    COPY 
$6.00    A    YEAR 


CONTENT 


Original  Articles 

Meeting-  North  Carolina's  Occupational  Health 
Needs  Through  Our  State  Agencies — Emil 
T.    Chamblett 357 

Economic  Influences  of  an  Industrial  Medical 
Program  on  a  Countv  Society — Mac  Ray 
Gasque,  M.D.,  and  Carl  S.  Plumb,  M.D.   .     .     361 

Compensable  Occupational  Diseases  Under  the 
North  Carolina  Workmen's  Compensation 
Act— J.    W.    Bean 365 

Radiation  Hazards  in  Industry — Thomas  S. 
Ely,    M.D 367 

Physical  Requirements  in  Textile  Manufac- 
turing— Charles    G.    Gunn,    Jr.,    M.D.    .     .     .     371 

The  Governor's  Council  on  Occupational 
Health:  A  Medium  of  Cooperative  Effort 
for  the  Health  of  the  Worker — William 
P.    Richardson,    M.D 377 

Clinical  Evaluation  of  the  Antacid  Properties 
of  Hydrated  Magnesium  Aluminate — David 
Cayer,   M.D.,  and   M.  Frank   Sohmer,   M.D.   .     380 

Mail  Order  Prescription  Services — H.  C.  Mc- 
Allister     382 

Editorials 

The    National    Election 385 

Sabin   Live-Virus   Polio   Vaccine   Approved    .     .  386 

Occupational    Health    Issue 387 

The    Speeding   Ambulance 387 

Mail    Order    Prescriptions 388 


Bulletin  Board 

Coming    Meetings 389 

New   Members  of   the   State    Society    ....     390 

News    Notes    from    the    Bowman    Gray    School 
of     Medicine 391 

News   Notes  from   the   Duke   University    Med- 
ical   Center "...     391 

News    Notes    from    the    University    of    North 

Carolina   School    of   Medicine 391 

Winston-Salem   Heart   Symposium 392 

North  Carolina  Board  of  Medical  Examiners  .  393 

County     Societies 393 

News     Notes        393 

Announcements 394 

Book  Reviews 

399 

In  Memoriam 

401 

Auxiliary 

Transactions     of    the     Thirty-seventh     Annual 
Session 403 

Roster    of    Members,    1959-1960 413 

Classified  Advertisements 

400 


President's  Message 

388 


Index  to  Advertisers 
lxxi 


Entered    as    second-class    matter    January    2.     1940,    at    the    Post    Office    at    Winston-Salem.    North    Carolina,    under    the    Act    of 
August  24,    1912.    Copyright    1960   by   the   Medical    Society   of   the  Stat*   of   North    Carolina. 


if? 


® 


SYRUP  OF  CHLORAL  HYDRATE 


NEW   RALDRATE   NOW   SOLVES   THE   PROBLEM 
OF  TASTE  RESISTANCE  TO  CHLORAL-HYDRATE 

10    Grains   (U.S. P.    Dose)    of    palatable    lime    flavored 
chloral-hydrate   syrup    in   each    teaspoonful 

RAPID  SEDATION  WITHOUT  HANGOVER 


JONES  and  VAUGHAN,  Inc.  Richmond  26 


,    VA. 


/w#r 


clinically  proven  efficacy 

in  relieving  tension . . .  curbing  hypermotility  and  excessive  secretion  in  G.  I.  disorders 


A 

^ 

95% 

EXCEL 

TRIDIHEXETHYL 

85% 

LENT 

lODIDEt 
MEPROBAMATE 

TRIDIHEXETHYL 
lODIDEt 

GO 

ij  ij&L  v 

86  PATIENTS               21  PATIENTS 

i 

5% 

FA 

IR 

15% 

BWTl 

OR 

PATHIBAMATE  combines  two  highly  effective  and 

well-tolerated  therapeutic  agents: 

Meprobamate— widely  accepted  tranquilizer 

and 
PATHILON  tridihexethyl  chloride— antichol- 
inergic noted  for  its  effect  on  motility  and 
gastrointestinal  secretion  with  few  unwanted 
side  effects. 

Contraindications:  glaucoma,  pyloric  obstruction,  and 
obstruction  of  the  urinary  bladder  neck. 


t 


METHANTHELINE 
BROMIDE 


1  ATROPINE  SULFATE 


PLACEBO 


colic 


I 


'31  PATIENTS 


62  PATIENTS  103  PATIENTS 


Two  available  dosage  strengths  permit  adjusting  therap; 
to  the  G.I.  disorder  and  degree  of  associated  tension. 


I 


Where  a  minimal  meprobamate  effect  is  preferred . 

PATHIBAMATE-200  Tablets:  200  mg.  of  meprobamate; 
25  mg.  of  PATHILON 

Where  a  full  meprobamate  effect  is  preferred . . . 

PATHIBAMATE-400  Tablets:  400  mg.  of  meprobamate; 
25  mg.  of  PATHILON 

Dosage:  Average  oral  adult  dose  is  1  tablet 
t.i.d.  at  mealtime  and  2  tablets  at  bedtime. 


' 


Pathibamate 

meprobamate  with  PATHILON® tridihexethyl  chloride  Lederle 


400 
200 


fi 


clinically  proven  safety 


The  efficacy  of  PATHIBAMATE  has  been  confirmed  Pictured  are  the  results  obtained  with  the  PATHILON 

clinically  in  duodenal  ulcer,  gastric  ulcer,  intestinal  (tridihexethyl  iodide)-meprobamate  combination!  in  a 

colic,  spastic  and  irritable  colon,  ileitis,  esophageal  double-blind  study  of  303  ulcer  patients,  extending  over 

spasm,  anxiety  neurosis  with  gastrointestinal  symp-  a  period  of  36  months.*  They  clearly  demonstrate  the 

toms,  and  gastric  hypermotility.  efficacyof  PATHIBAMATE  in controllingthesymptoms. 


SIDE  EFFECTS 


DRY  MOUTH 


TRIDIHEXETHYL 

lODIDEt 
MEPROBAMATE 


SAME  OR  MORE 


TRIDIHEXETHYL 
lODIDEt 


5% 


0% 


0% 


0% 


0% 


9% 


0% 


5% 


23% 


62% 


15% 


METHANTHELINE 
BROMIDE 


72% 


28% 


50% 


18% 


0% 


3% 


0% 


5% 


25% 


52% 


23% 


ATROPINE  SULFATE 


46% 


14% 


34% 


11% 


0% 


9% 


6% 


14% 


17% 


37% 


46% 


PLACEBO 


5% 


0% 


1% 


1% 


0% 


10% 


0% 


2% 


26% 


24% 


50% 


*Atwater,  J.  S.,  and  Carson,  J.  M.:  Therapeutic  Principles  in  Management  of  Peptic  Ulcer.  Am.  J.  Digest.  Dis.  4:1055  (Dec.)  1959. 

fPATHILON  is  now  supplied  as  tridihexethyl  chloride  Instead  of  the  iodide,  an  advantage  permitting  wider  use,  since  the  latter  could 
distort  the  results  of  certain  thyroid  function  tests. 


y^£)  LEDERLE  LABORATORIES,  A  Division  of  AMERICAN  CYANAMID  COMPANY,  Pearl  River,  New  York 

control  the  tension  -  treat  the  trauma 


a  new,  improved, 
more  potent  relaxant 
for  anxiety  and  tension 


effective  in  half  the  dosage  required  with  meprobamate 

much  less  drowsiness  than  with  meprobamate, 
phenothiazines,  or  the  psychosedatives 

does  not  impair  intellect,  skilled  performance,  or  normal  behavior 

neither  depression  nor  significant  toxicity  has  been  reported 


alert  tranquillity 


EMYLCAMATE 


a  familiar  spectrum  of  antianxiety  and  muscle-relaxant  activity 

no  new  or  unusual  effects— such  as  ataxia  or  excessive  weight  gain 

may  be  used  in  full  therapeutic  dosage  even  in  geriatric  or  debilitated  patients 

no  cumulative  effect 

simple,  uncomplicated  dosage,  providing  a  wide  margin  of  safety  for  office  use 

STRIATRAN  is  indicated  in  anxiety  and  tension,  occurring  alone  or  in 

association  with  a  variety  of  clinical  conditions. 

Adult  Dosage:  One  tablet  three  times  daily,  preferably  just  before  meals. 

In  insomnia  due  to  emotional  tension,  an  additional  tablet  at  bedtime  usually 

affords  sufficient  relaxation  to  permit  natural  sleep. 

Supply:  200  mg.  tablets,  coated  pink,  bottles  of  100. 

While  no  absolute  contraindications  have  been  found  for  Striatran  in  full  recommended  dosage, 
the  usual  precautions  and  observations  for  new  drugs  are  advised. 

For  additional  information,  write  Professional  Services, 
Merck  Sharp  &  Dohme.  West  Point,  Pa. 

MERCK  SHARP  &.  DOHME,  division  of  merck  &.  co.,  inc..  west  point,  pa. 

STRIATRAN   IS  A  TRADEMARK  OF  MERCK  &  CO.,  INC. 


VIII NORTH   CAROLINA   MEIHi'Al.   J()li:XAI. September,   l'.ici) 

Medical  Society  of  the  State  of  North  Carolina 

OFFICERS  —  1960 

President — Amos  Neill  Johnson,  M.D.,  Garland 

President  Elect — Claude  B.  Squires,  M.D.,  225  Hawthorne  Lane,  Charlotte 
Past  President — John  C.  Reece,  M.D.,  Grace  Hospital,  Morganton 
First  Vice-President — Theodore  S.  Raiford,  M.D.,  Doctors  Building,  Asheville 
Second  Vice-President — Charles  T.  Wilkinson,  M.D.,  Wake  Forest 
Secretary — John  S.  Rhodes,  M.D.,  700  West  Morgan  Street,  Raleigh 
Executive  Director — Mr.  James  T.  Barnes,  203  Capital  Club  Building,  Raleigh 
The   President,   Secretary   and   Executive   Director  are  members   ex-officio 

of  all  committees 
Speaker-House  of  Delegates — Donald  B.  Koonce,  M.D.,  408  N.   11th  St.,  Wilmington 
Vice-Speaker-House  of  Delegates — E.  W.  Schoenheit,  M.D.,  46  Haywood  St.,  Asheville 


COUNCILORS  —  1958  -  1961 

First  District^-T.  P.  Brinn,  M.D.,  118  W.  Market  Street,  Hertford 

Vice  Councilor — Q.  E.  Cooke,  M.D.,  Murfreesboro 
Second  District — Lynwood  E.  Williams,  M.D.,  Kinston  Clinic,  Kinston 

Vice  Councilor — Ernest  W.  Larkin,  Jr.,  M.D.,  211  N.  Market  St.,  Washington 
Third  District — Dewey  H.  Bridger,  M.D.,  Bladenboro 

Vice  Councilor — William  A.  Greene,  M.D.,  104  E.  Commerce  St.,  Whiteville 
Fourth  District — Edgar  T.  Beddingfield,  Jr.,  M.D.,  P.O.  Box  137,  Stantonsburg 

Vice  Councilor — Donnie  H.  Jones,  M.D.,  Box  67,  Princeton 
Fifth  District— Ralph  B.  Garrison,  M.D.,  222  N.  Main  Street,  Hamlet 

Vice  Councilor — Harold  A.  Peck,  M.D.,  Moore  County  Hospital,  Pinehurst 
Sixth  District — George  W.  Paschal,  Jr.,  M.D.,  1110  Wake  Forest  Rd.,  Raleigh 

Vice  Councilor — Rives  W.  Taylor,  M.D.,  P.O.  Box  1191,  Oxford 
Seventh  District — 

Vice  Councilor— Edward  S.  Bivens,  M.D.,  Stanly  County  Hospital,  Albemarle 
Eighth  District— Merle  D.  Bonner,  M.D.,  1023  N.  Elm  Street,  Greensboro 

Vice  Councilor — Harry  L.  Johnson,  M.D.,  P.O.  Box  530,  Elkin 
Ninth  District — Thomas  Lynch  Murphy,  M.D.,  116  Rutherford  St.,  Salisbury 

Vice  Councilor — Paul  McNeely  Deaton,  M.D.,  766  Hartness  St.,  Statesville 
Tenth  District — William  A.  Sams,  M.D.,  Main  Street,  Marshall 

Vice  Councilor — W.  Otis  Duck,  M.D.,  Drawer  517,  Mars  Hill 

DELEGATES  TO  THE  AMERICAN  MEDICAL  ASSOCIATION 

Elias  S.  Faison,  M.D.,  1012  Kings  Drive,  Charlotte 

C.  F.  Strosnider,  M.D.,  111  E.  Chestnut  Street,  Goldsboro 

Millard  D.  Hill,  M.D.,  15  W.  Hargett  Street,  Raleigh 

William  F.  Hollister,  M.D.,  (Alternate),  Pinehurst  Surgical  Clinic,  Pinehurst 

Joseph  F.  McGowan,  M.D.,    (Alternate),  29  Market  Street,  Asheville 

Wm.  McN.  Nicholson,  M.D.,   (Alternate),  Duke  Hospital,  Durham 

SECTION  CHAIRMEN  1959-1960 

General  Practice  of  Medicine — Julius  Sader,  M.D.,  205  East  Main  Street,  Brevard 
Internal  Medicine — Walter  Spaeth,   M.D.,  116   South  Road,  Elizabeth  City 
Ophthalmology  and  Otolaryngology — Charles  W.  Tillett,  Jr.,  M.D.,  1511   Scott 

Avenue,  Charlotte 
Surgery — James  E.  Davis,  M.D.,  1200  Broad  Street,  Durham 
Pediatrics — William  W.  Farley,  M.D.,  903  West  Peace  Street,  Raleigh 
Obstetrics  &  Gynecology — H.  Fleming  Fuller,  M.D.,  Kinston  Clinic,  Kinston 
Public  Health  and  Education — ISA  C.  Grant,  M.D.,  Box  949,  Raleigh 
Neurology  &  Psychiatry — Myron  G.  Sandifer,  M.D.,  N.  C.  Memorial  Hospital, 

Chapel  Hill 
Radiology — Isadore  Meschan,  M.D.,  Bowman  Gray  School  of  Medicine, 

Winston-Salem 
Pathology — Roger  W.  Morrison,   M.D.,  65   Sunset  Parkway,  Asheville 
Anesthesia — Charles  E.  Whitcher,  M.D.,  Route  1,  Pfafftown 
Orthopedics  &  Traumatology — Chalmers  R.  Carr,  M.D.,   1822   Brunswick   Avenue, 

Charlotte 
Student  AMA  Chapters — Mr.  John  Feagin,  Duke  University  School  of  Medicine. 

Durham 


September,  1960 


ADVERTISEMENTS 


IX 


YEARS 


senile 
anxiety 

disorientation 

agitation 

hostility 

irritability 

apprehension 

hysteria 

insomnia 

chronic 
urticaria 

alcoholism 

menopausal 
syndrome 

neuro- 
dermatoses 

functional 

gastrointestinal 

disorders 

psychoneuroses 

tension 

headaches 

dysmenorrhea 

psychosomatic 
complaints 

situational 
stress 

asthma 

hyperactivity 

tics 

preoperative 
anxiety 

enuresis 
behavior 
problems 


ATARAX  ENCOMPASSES  MORE  PATIENT  NEEDS... LETS  YOU 
CHART  A  SAFER,  MORE  EFFECTIVE  COURSE  TO  TRANQUILITY 


Atarax  has  a  wide  range  of  flexibility  . .  .  from 
mild  adult  tensions  and^anxieties  to  full-blown 
alcoholic  episodes  .  .  .  from  the  behavior  dis- 
orders of  childhood  to  the  emotional  problems 
of  old  age.  Why?  Because  it  gives  you  maximum 
adaptability  of  dosage  .  .  .  works  quickly  and 
predictably  ...  is  unsurpassed  in  safety. 

Atarax  offers  extra  pharmacologic  actions 
especially  useful  in  certain  troublesome  con- 
ditions. It  is  antihistaminic  and  mildly  anti- 
arrhythmic, does  not  stimulate  gastric  secre- 
tions. Hence  it  is  well  suited  to  the  needs  of 
your  allergic,  cardiac  and  ulcer  patients. 

Have  you  discovered  all  the  benefits  of 

ATARAX? 

Dosage:  Adults,  one  25  mg.  tablet,  or  one  tbsp.  Syrup 
q.i.d.  Children,  3-6  years,  one  10  mg.  tablet  or  one  tsp. 
Syrup  t.i.d.;  over  6  yeprs,  two  10  mg.  tablets  or  two  tsp. 
Syrup  t.i.d. 


Supplied:  Tiny  10  mg.,  25  mg.,  and  100  mg.  tablets,  bot- 
tles of  100.  Syrup,  pint  bottles.  Parenteral  Solution: 
25  mg./cc.  in  10  cc.  multiple-dose  vials;  50  mg./cc.  in 
2  cc.  ampules.  Prescription  only. 

Complete  bibliography  available  on  request. 

at  a  MX 


(BRAND  OF  HYDROXYZINE) 


PASSPORT  TO  TRANQUILITY 


New  York  17,  N.  Y. 

Division,  Chas.  Pfizer  &  Co.,  Inc. 

Science  for  the  World's  Well-Being" 


VITERRA 


(g)  for  vitamin-mineral  supplementation 
capsules  *  tastitabs® 
therapeutic  capsules 


In  over  five  yean 


Proven 

in  more  than  750  published  clinical  studies 

Effective 

for  relief  of  anxiety  and  tension 

Outstandingly  Safe 

1     simple  dosage  schedule  produces  rapid,  reliable 
tranquilization  without  unpredictable  excitation 

2     no  cumulative  effects,  thus  no  need  tor  difficult 
dosage  readjustments 

r\     does  not  produce  ataxia,  change  in  appetite  or  libido 

does  not  produce  depression,  Parkinson-like  symptoms, 
^     jaundice  or  agranulocytosis 

S     does  not  impair  mental  efficiency  or  normal  behavior 


Milt  own 

meprobamate  {Wallace) 

Usual  dosage:  One  or  two  400  mg.  tabids  t.i.d. 
Supplied:  400  my.  scored  tabids,  "00  ins*.  sni;ai  -mated  tablets. 
Also  as  mH'Koi'abs*  —  400  nig,  unmarked,  coated  tablets;  and 
as  mi j'Kosi'AY- —  1UU  nig.  and  200  nig.  continuous  release  capsules. 

\¥/*  WALLACE  LABORATORIES  /  Cranbitiy,  N.  /. 


( 


\ 


of  clinical  use 


...  for  the  tense  and  nervous  patient 

Despite  the  introduction  in  recent  years  of  "new  and  different"  tranquil- 
izers, Miltown  continues,  quietly  and  steadfastly,  to  gain  in  acceptance. 
Meprobamate  (Miltown)  is  prescribed  by  the  medical  profession  more  than 
any  other  tranquilizer  in  the  world. 

The  reasons  are  not  hard  to  find.  Miltown  is  a  known  drug.  Its  few  side 
effects  have  been  fully  reported.  There  are  no  surprises  in  store  for  either 
the  patient  or  the  physician. 


u 


Gratifying"  relief  from 


for  your  patients  with 
'low  back  syndrome'  and 
other  musculoskeletal  disorders 

POTENT  muscle  relaxation 
EFFECTIVE  pain  relief 
SAFE  for  prolonged  use 


stiffness  and  pain 

i^XdXll  y  llli^     relief  from  stiffness  and  pain 

in  106-patient  controlled  study 

(as  reported  mJ.A.M.A.,  April  30,  1960) 

"Particularly  gratifying  was  the  drug's  [Soma's] 
ability  to  relax  muscular  spasm,  relieve  pain,  and 
restore  normal  movement  ...  Its  prompt  action, 
ability  to  provide  objective  and  subjective  assist- 
ance, and  freedom  from  undesirable  effects  rec- 
ommend it  for  use  as  a  muscle  relaxant  and  anal- 
gesic drug  of  great  benefit  in  the  conservative 
management  of  the  'low  back  syndrome'." 

Kestler,  O.:  Conservative  Management  of  "Low  Back  Syndrome" , 

J.A.M.A.  172:  2039  (April  30)  I960. 

FASTER  IMPROVEMENT-  79%  complete  or  marked 

improvement  in  7  days  (Kestler) 

EASY  TO  USE— Usual  adult  dose  is  one  350  mg.  tablet 
three  times  daily  and  at  bedtime. 

SUPPLIED:  350  mg.,  white  tablets,  bottles  of  50. 

For  pediatric  use,  250  mg.,  orange  capsules,  bottles  of  50. 

Literature  and  samples  on  request. 


(CARISOPRODOL,  WALLACE) 


ygf  WALLACE    LABORATORIES,    CRANBURY,    NEW   JERSEY 


now-for 
more  comprehensive 

control  of 


INDICATIONS 

Head:  temporomandibular 
muscle  spasm  •  Neck:  acute 
torticollis,  osteoarthritis  of  cer- 
vical spine  with  spasm  of  cervical 
muscles,  whiplash  injury  •  Trunk  and  Chest:  costochondritis,  intercostal  myositis,  xiphodynia  •  Back: 
acute  and  chronic  lumbar  strains  and  sprains,  acute  low  back  pain  (unspecified),  acute  lumbar  arthritis 
and  traumatic  injury,  compression  fracture,  herniated  intervertebral  disc,  post-disc  syndrome,  strained 
muscle(s)  •  Extremities:  acute  hip  injury  with  muscle  spasm,  ankle  sprain,  arthritis  (as  of  foot  or  knee), 
blow  to  shin  followed  by  muscle  spasm,  bursitis,  spasm  or  strain  of  muscle  or  muscle  group,  old  fracture 
with  recurrent  spasm,  Pellegrini-Stieda  disease,  tenosynovitis  with  associated  pain  and  spasm. 


-pain  due  to 

or 
-spasm  of  skeletal  muscle 

a  new  muscle  relaxant-analgesic 


Many  conditions,  painful  in  themselves,  often  give  rise  to  spasm  of  skeletal  muscles. 
ROBAXISAL,  the  new  dual-acting  muscle  relaxant-analgesic,  treats  both  the  pain  and 
the  spasm  with  marked  success:  In  clinical  studies  on  311  patients,  12  investigators1 
reported  satisfactory  results  in  86.5%.  Each  ROBAXISAL  Tablet  contains: 

•  A  relaxant  component— Robaxin*  — widely  recognized  for  its  prompt   long-lasting  relief  of 
painful  skeletal  muscle  spasm,  with  unusual  freedom  from  undesired  side  effects WU  mg. 

•  Methocarbamol  Robins.  U.S.  Pat.  No.  2770649- 

.  An  analgesic  component— aspirin— whose  pain-relieving  effect  is  markedly  enhanced  by  Robaxin, 
and  which  has  added  value  as  an  anti-inflammatory  and  anti-rheumatic  agent.  . .  .  (i  gr.)  JZi  mg. 


INDICATIONS:  Robaxisal  is  indicated  when  analgesic  as 
well  as  relaxant  action  is  desired  in  the  treatment  of  skeletal 
muscle  spasm  and  severe  concurrent  pain.  Typical  condi- 
tions are  disorders  of  the  back,  whiplash  and  other  trau- 
matic injuries,  myositis,  and  pain  and  spasm  associated  with 
arthritis. 


SUPPLY:  Robaxisal  Tablets  (pink-and-white,  laminated) 
in  bottles  of  100  and  500. 

Also  available:  Robaxin  Injectable,  1.0  Gm.  in  10-cc  am- 
pul. Robaxin  Tablets,  0.5  Gm.  (white,  scored)  in  bottles  of 
50  and  500. 


■Clinical  reports 
C.  Freeman,  Jr. 
Chicago  Heights, 


lorts  in  files  of  A   H    Robins  Co..  Inc..  from:  J.  Allen,  Madison.  Wise..  B.  Billow.  New  York    N.  Y     B.  Decker.  Richmond    Va 
*£.  Aulusta  Ga.    k.  B   Gordon,  New  York.  NY.,  J.  E.  Holmblad    Schenectady.  N    Y.    L    Ley.  New  York    N.  Y     N    Lo  Bue. 
ights\  HI  .  H.  Nachman.  Richmond.  Va..  A.  Poindexier.  Los  Angeles.  Cal..  E.  Rogers.  Brooklyn.  N.  Y  .  K.  H.  Strong.  rairteld.  la. 

Additional  information  available  upon  request. 

Making  today's  medicines  with  integrity . . .  seeking  tomorrow's  with  persistence 


XIV 


NORTH  CAROLINA  MEDICAL  JOURNAL 


September,  1960 


Sep 


When  you  want  to  reduce  serum  cholesterol 

and  maintain  it  at  a  low  level,  is  medication  more 

realistic  than  dietary  modifications? 


Maintenance  of  lowered  cholesterol  concentration  in  the  blood 
is  a  life-long  problem.  It  is  usually  preferable,  therefore, 
to  try  to  obtain  the  desired  results  through  simple 
dietary  modification.  This  spares  the  patient  added  expense 
and  permits  him  meals  he  will  relish. 


The  modification  is  based  on  a  diet  to  maintain 

optimum  weight  plus  a  judicious  substitution 

of  the  poly-unsaturated  oils  for  the  saturated  fats. 

One  very  simple  part  of  the  change  is  to  cook  the 

selected  foods  with  poly-unsaturated  Wesson. 

In  the  prescribed  diet,  this  switch  in  type  of  fat 

will  help  to  lower  blood  serum  cholesterol  and 

help  maintain  it  at  low  levels.  The  use  of  Wesson 

permits  a  diet  planned  around  many  favorite 

and  popular  foods.  Thus  the  patient  finds  it  a 

pleasant,  easy  matter  to  adhere  to  the  prescribed  course. 


Where  a  vegetable  (salad)  oil  is  medically  recom- 
mended lor  a  cholesterol  depressant  regimen,  Wesson 
is  unsurpassed  by  any  readily  available  brand. 
Uniformity  you  can  depend  on.  Wesson  has  a  poly- 
unsaturated content  better  than  50%  .  Only  the  lightest 
cottonseed  oils  of  highest  iodine  number  are  selected 
for  Wesson.  No  significant  variations  are  permitted  in 
the  22  exacting  specifications  required  before  bottling. 


Wesson  satisfies  the  most  exacting  appetites.  To    be 

effective,  a  diet  must  be  eaten  by  the  patient.  The 
majority  of  housewives  prefer  Wesson  particularly  by 
the  criteria  of  odor,  flavor  (blandness)  and  lightness  of 
color.  (Substantiated  by  sales  leadership  for  59  years 
and  reconfirmed  by  recent  tests  against  the  next 
leading  brand  with  brand  identification  removed,  among 
a  national  probability  sample.) 


September,  19G0 


ADVERTISEMENTS 


XV 


Chicken,  grilled  with  homemade 
Wesson  barbecue  sauce,  is  low  in 
saturated  fat — and  delicious  eating. 
It  gives  longer  lasting  satisfaction. 


FREE  Wesson  recipes,  available  in 

quantity  for  your  patients,  show  how  to 
prepare  meats,  seafoods,  vegetables,  salads 
and  desserts  with  poly-unsaturated 
vegetable  oil.  Request  quantity  needed  from 
The  Wesson  People,  Dept.  N., 

210  Baronne  St.,  New  Orleans  12,  La 


Wesson's  Important  Constituents 

Wesson  is  100%  cottonseed  oil  .  .  . 

winterized  and  of  selected  quality 
linoleic  acid   glycerides   (poly-unsaturated)  50-55% 

Oleic  acid  glycerides  (mono-unsaturated)  16-20% 

Total  unsaturated  70-75% 

Palmitic,  stearic  and  myristic  glycerides  (saturated)  25-30% 
Phytosterol    (predominantly   beta    sitosterol)  0.3-0.5% 

Total   tocopherols  0.09-0.12% 

Never   hydrogenated— completely   salt   free 


XVI NORTH  CAROLINA  MEDICAL  JOURNAL  September,  1960 


WHEN  ULCEROGENIC  FACTORS  KEEP  ON  WORKING... 


September,  1960 


ADVERTISEMENTS 


XVII 


REMEMBER  THIS:  SO  DOES  ENARAX 


Think  of  your  patient  with  peptic  ulcer— or  with  gastrointestinal 
dysfunction  — on  a  typical  day. 

Think  of  the  anxieties,  the  tensions. 

Think,  too,  of  the  night:  the  state  of  his  stomach  emptied  of  food. 

Disturbing? 

Then  think  of  enarax.  For  enarax  was  formulated  to  help  you  control  pre- 
cisely this  clinical  picture,  enarax  provides  oxyphencyclimine,  the  in- 
herently long-acting  anticholinergic  (up  to  9  hours  of  actual  achlorhydria1) 
.  . .  plus  Atarax,  the  tranquilizer  that  doesn't  stimulate  gastric  secretion. 

Thus,  with  b.i.d.  dosage,  you  provide  continuous  antisecretory/antispas- 
modic action  and  safely  alleviate  anxiety .  .  .  with  these  results:  enarax 
has  been  proved  effective  in  92%  of  G.I.  patients.2-4 

When  ulcerogenic  factors  seem  to  work  against  you,  let  enarax  work 
for  you. 

ENARAX 

(lO  MG.  OXYPHENCYCLIMINE  PLUS  25  MG.  ATARAX®!)  A     SENTRY     FOR    THE    G.I.    TRACT 

dosage:  Begin  with  one-half  tablet  b.i.d. —  preferably  in  the  morning  and  before  retiring. 
Increase  dosage  to  one  tablet  b.i.d.  if  necessary,  and  adjust  maintenance  dose  according 
to  therapeutic  response.  Use  with  caution  in  patients  with  prostatic  hypertrophy  and  only 
with  ophthalmological  supervision  in  glaucoma. 

supplied:  In  bottles  of  60  black-and-white  scored  tablets.  Prescription  only. 

References:  1.  Steigmann,  F.,  et  al.:  Am.  J.  Gastroenterol.  33:109  (Jan.)  1960.  2.  Hock,  C.  W.: 
to  be  published.  3.  Leming,  B.  H.,  Jr.:  Clin.  Med.  6:423  (Mar.)  1959.  4.  Data  in  Roerig  Medical 

Department  Files.  tbrand  of  hydroxyzine 


FOR  HEMATOPOIETIC  STIMULATION 
WHERE  OCCULT  BLEEDING  IS  PRESENT 

HEPTUNA®  PLUS 

THE  COMPLETE  ANEMIA  THERAPY 


New  York  17,  N.Y. 

Division,  Chas.  Pfizer  &  Co.,  Inc. 

Science  for  the  World's  Well-Being ' 


completely  c 


f  the  common  cold 


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your  patients  suffering  from  colds,  respiratory  disorders  and  allergic  states,  you  will 
CONTRAMAL-CP  an  orally  effective  DECONGESTANT,  ANALGESIC,  ANTIPYRE- 
and  ANTIHISTAMINE.  The  inclusion  of  Tristamine*  and  Phenylephrine  Hydrochlo- 
with  the  basic  CONTRAMAL  formula  is  designed  to  provide  .  .  .  MORE  complete 
rol  of  the  common  cold! 


V 


*A 


stam 


by  Physicians  Products  Company 
ontains  Chlorpheniramine  Maleate 
.25  mg.,  Phenyltoloxamine  Citrate 

6.25  mg.,  and  Pyrilamine  Maleate 
2.5  m 


i 


r 


Mi 


\ 


TRAMAL-CP  .  . 
orange  capsule  con 

Acetyl-p-aminophenol 

Salicylamide 
Caffeine 
henylephrine    Hydrochloride 

At    ' 

ristamine  ■ 


30  mg. 

5  mg. 

20  mg. 


V 


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samples -And 
literature 
gladly  sent 
upon  request, 


PRODUCTS  CO.,   INC. 

PETERSBURG,    VIRGINIA 


effective  oral  skeletal 
muscle  relaxant 
and  tranquilizer 


LETS  THE  PATIENT  WALK 
"HEADS  UP" 

in  spite  of  torticollis. 


-^m^-^mmm 


Trancopal 

relieves  pain  and  spasm 
associated  with  torticollis. 

In  a  recent  study  by  Ganz,  Trancopal  brought  considerable 
improvement  or  very  effective  relief  to  20  of  29  patients 
with  torticollis.1  "The  patients  helped  by  the  drug,"  states 
Ganz,  "were  able  to  carry  the  head  in  the  normal  position 
without  pain."  Similarly,  Kearney  found  that  in  8  of  13 
patients  with  chronic  torticollis  treated  with  Trancopal 
improvement  was  excellent  to  good.  ". . .  Trancopal  is  the  most 
effective  oral  skeletal  muscle  relaxant  and  mild  tranquilizer 
currently  available."2 

Lichtman,  in  a  study  of  patients  with  various  musculoskel- 
etal conditions,  noted  that  64  of  70  patients  with  torticollis 
obtained  excellent  to  good  relief  with  Trancopal.3 

In  a  comparative  study  of  four  central  nervous  system 
relaxants,  Lichtman  reports  that  26  of  40  patients 
found  Trancopal  to  be  the  most  effective  drug.3 


Trancopal  (brand  of  chlormezanone)  and  Caplets,  trademarks  reg.  U.  S.  Pat.  Off.        4716 


1.  Ganz.  S.  E.:  J.  Indiana  A 
52:1134.  July,  1959.  2.  Kearney,  I 
Current  Therap.  Res.  2:127 
1960.  3.  Lichtman.  A.  L.:  Ken 
Acad.  Gen.   Pract.  J.  4:28.   Oct., 


Olinical  results  with 

IrancopaF 

Excellent 

Good 

Fair 

Poor 

Total 

LOW  BACK  SYNDROMES 

Acute  low  back  strain 
Chronic  low  back  strain 
"Porters'  syndrome"* 
Pelvic  fractures 

25 

11 

21 

2 

19 
5 
5 
1 

8 
1 
1 

6 
1 

1 

58 

18 

28 

3 

NECK  SYNDROMES 

Whiplash  injuries 
Torticollis,  chronic 

12 
6 

6 
2 

2 

3 

1 
2 

21 
13 

OTHER  MUSCLE  SPASM 

Spasm  related  to  trauma 
Rheumatoid  arthritis 
Bursitis 

15 
2 

6 

18 

6 

1 
2 
1 

1 

22 

21 
9 

TENSION  STATES 

18 

2 

4 

3 

27 

TOTALS 

112 
(51%) 

70 
(32%) 

23 

(10%) 

15 

(7%) 

220 

(100%) 

*Over-reaching  in  lifting  heavy  bags  resulting  in  sprain  of  upper,  middle,  and  lower  back  muscles. 


Dosage:  Adults,  200  or  100  mg.  orally  three  or  four  times  daily. 

Relief  of  symptoms  occurs  in  from  fifteen  to  thirty  minutes  and  lasts  from  four  to  six  hours. 

How  Supplied:  Trancopal  Caplets® 

200  mg.  (green  colored,  scored),  bottles  of  100. 
100  mg.  (peach  colored,  scored),  bottles  of  100. 


I  Ijtiitn/iob 


LABORATORIES,  New  York  1 8,  N.  Y. 


XX 


NORTH  CAROLINA  MEDICAL  JOURNAL 


September.  ISmO 


a 


extraordinarily  effective  diuretic..'!1 


Efficacy  and  expanding  clinical  use  are  making  Naturetin  the 
"diuretic  of  choice"2  in  edema  and  hypertension.  It  maintains  a 
favorable  urinary  sodium-potassium  excretion  ratio,  retains  a 
balanced  electrolyte  pattern,  and  causes  a  relatively  small  in- 
crease in  the  urinary  pH.3  More  potent  than  other  diuretics, 
Naturetin  usually  provides  18-hour  diuretic  action  with  just  a 
single  5  mg.  tablet  per  day  —  economical,  once-a-day  dosage 
for  the  patient.  Naturetin  c  K  —  for  added  protection  in  those 
special  conditions  predisposing  to  hypokalemia  and  for  patients 
on  long-term  therapy. 


Supplied:  Naturetin  Tablets,  5  mg.,  scored,  and  2.5  mg.  Naturetin 
c"  K  (5  c  500)  Tablets,  capsule-shaped,  containing  5  mg.  ben- 
zydroflumethiazide  and  500  mg.  potassium  chloride.  Naturetin 
c  K  (2,5  c  500)  Tablets,  capsule-shaped,  containing  2.5  mg. 
benzydroflumethiazide  and  500  mg.  potassium  chloride.  For  com- 
plete information  consult  package  circular  or  write  Professional 
Service  Dept.,  Squibb,  745  Fifth  Avenue,  New  York  22,  N.  Y. 

Pe/erences:  1.  Dovid,  N.  A.;  Porter,  G.  A.,  and  Gray,  R.  H.:  Monographs 
on  Theropy  5:60  (Feb.)  1960.  2.  Friend,  D.  H.;  Clin.  Pharm.  &  Therap.  1:5 
(Mar.-Apr.)    1960.   3.   Ford,   R.  V.:  Current  Therap.   Res.   2:92   (Mar.)    1960. 


Naturetin  Naturetin °K 


Squibs 


September,  1960 


ADVERTISEMENTS 


XXI 


A.  H.  Robins' 
new  Adabee  — 
for  the  physician 
ivho  has 
iveighed  the  .  .  . 


MOUNTING 
EVIDENCE 


AGAINST 


IN 

MULTI- 
VITAMINS 


Bi2AND 
FOLIC  ACID 


jouroji  of  Medicim: 


rj 


"^•^^Lj 


Individually,  folic  acid  and  B12  fill  important  clinical  roles.1 
But,  increasing  evidence  indicates  that  multivitamins  con- 
taining folic  acid  may  obscure  the  diagnosis  of  pernicious 
anemia.2"7  And  vitamin  B12.  in  indiscriminate  and  unneces- 
sary usage5"8  is  likewise  blamed  for  this  diagnostic  con- 
fusion.7 

Both  folic  acid  and  B12  have  been  omitted  from  Adabee,  in 
recognition  of  this  growing  medical  concern.  Also  excluded 
are  other  factors  which  might  interfere  with  concurrent  ther- 
apy, such  as,  hormones,  enzymes,  amino  acids,  and  yeast 
derivatives.  Adabee  supplies  massive  doses  of  therapeutically 
practical  vitamins  for  use  in  both  specific  and  supportive 
schedules  in  illness  and  stress  situations.  Thus,  new  Adabee 
offers  the  therapeutic  advantage  of  sustained  maximum 
multivitamin  support  without  the  threat  of  symptom-masking. 

references:  1.  Wintrobe,  M.  M.,  Clinical  Hematology,  3rd  ed., 
Phila.,  Lea  &  Febiger,  1952,  p.  398.  2.  Goodman,  L.  S.  and  Gilman, 
A.,  The  Pharmacological  Basis  of  Therapeutics,  2nd.  ed.,  New 
York,  Macmillan,  1955,  p.  1709.  3.  New  Eng.  J.M.,  Vol.  259,  No. 
25,  Dec.  18,  1958,  p.  1231.  4.  Frohlich,  E.  D.,  New  Eng.  J.M., 
259:1221,  1958.  5.  J.A.M.A.,  169:41,  1959.  6.  J.A.M.A.,  173:240, 
1960.  7.  Goldsmith,  G.  A.,  American  J.  of  M.,  25:680,  1958.  8. 
Darby,  W.  J.,  American  J.  of  M.,  25:726,  1958. 


ADABEE® 

Each  yellow,  capsule-shaped  tablet  contains: 


Vitamin  A 
Vitamin  D 

Thiamine  mononitrate  (Bj) 
Riboflavin  (Bo) 
Pyridoxine  HC1  (B6) 
Nicotinamide  (niacinamide) 
Calcium  pantothenate 
Ascorbic  acid  (vitamin  C) 

ADABEE?  M 

Each  green,  capsule-shaped  tablet  contains  Adabee  plus  nine 
essential  minerals: 


25,000  USP  units 

1,000  USP  units 

15  mg. 

10  mg. 

5  mg. 

50  mg. 

10  mg. 

250  mg. 


Iron 

15.0    mg. 

Zinc 

1.5 

mg. 

Iodine 

0.15  mg. 

Potassium 

5.0 

mg. 

Copper 

1.0   mg. 

Calcium 

103.0 

mg. 

Manganese 

1.0    mg. 

Phosphorus 

80.0 

mg. 

Magnesium 

6.0    mg. 

indications:  As  dietary  supplements  for  the  deficiency  states 
that  accompany  pregnancy  and  lactation,  surgery,  burns, 
trauma,  alcohol  ingestion,  hyperthyroidism,  infections,  car- 
diac disease,  polyuria,  anorexia,  cirrhosis,  arthritis,  colitis, 
diabetes  mellitus.  and  degenerative  diseases.  Also  in  re- 
stricted diets,  particularly  peptic  ulcer,  in  geriatrics,  and  in 
concurrent    administration    with    diuretics    and    antibiotics. 

dosage:  One  or  more  tablets  a  day,  as  indicated,  preferably 
with  meals.  _  _ 

new!  ADABEE 

the  multivitamin  without  B12  or  folic  acid 

A.  H.  ROBINS  COMPANY,  INC. 

Richmond  20,  Virginia 


I  wouldn't  be  hooting 
all  night  if  I  were  able 
to  get  my  beak  on  some 

TRIAMINIC® 

to  clear  up  my 
stuffed  sinuses." 


= 


Your  patient  with  sinus  congestion  doesn't  give  a  hoot  about  anything 

but  prompt  relief.  And  TRIAMINIC  has  a  pharmacologically  balanced 

formula  designed  to  give  him  just  that.  As  soon  as  he  swallows  the 

and  for  humans  tablet,  the  medication  is  transported  systemically  to  all  nasal  and 

paranasal  membranes  —  reaching  inaccessible  sinus  cavities  where 
With  ol  U  if  r  hi D -  U  XT  drops  and  sprays  can  never  penetrate.  TRIAMINIC  thereby  brings 

q TTsjTTQTfC;  more  complete,  more  effective  relief  without  hazards  of  topical  ther- 

apy, such  as  ciliary  inhibition,  rebound  congestion,  and  "nose  drop 
addiction." 

hid icat ions:  nasal  and  paranasal  congestion,  sinusitis,  postnasal  drip, 
upper  respiratory  allergy. 

Relief  is  prompt  and  prolonged  Each   Triaminic  timed-release  Tablet  provides: 

because  of  this  special  timed-release  action:  raSffiSTSJKrt!  HC'. :.'.'.'.'.'.'.'.'.'.'.. .  IsSfi 

Pyrilamine  maleate  25  mg. 

fir<tt  —the  outer  laver  Dosage:  1  tablet  in  the  morning,  midafternoon  and  at  bedtime. 

^A^K       dissolves  within  '"  Postnasal  drip,  1  tablet  at  bedtime  is  usually  sufficient. 

_  ^     minutes  to  produce  Each  timed-release  Triaminic  Juvelet®  provides: 

^^^^  I     3  to  4  hours  of  relief  ,.   ..      .  ...         .  ..     _  .       .    .    _,  ,,  . 

^^    \^_     ^/  %  the  formulation  of  the  Triaminic  Tablet. 

"~^\        ^nen  — the  core  Dosage:  1  Juvelet  in  the  morning,  midafternoon  and  at  bedtime, 

disintegrates  to  ,-,      ,  ,_       ,  ,      ,  _,   .       .    .     „  ., 

give  3  to  4  more  Each  tsp-  (5  ml^  °*  "TOfllMltC  Syrup  provides: 

hours  of  relief  %  the  formulation  of  the  Triaminic  Tablet. 

Dosage  (to  be  administered  every  3  or  4  hours) : 
Adults  — 1  or  2  tsp.;  Children  6  to  12  —  1  tsp.; 
Children  1  to  6  —  %  tsp.;  Children  under  1  —  lA  tsf. 

JL.    -LT\j  JL^Tjk.  XV JL  -L  JL^I     J-  \~*S      timed-release  tablets,  juvelets,  and  syrup 


running  noses  '-^>     ^-,  and  open  stuffed  noses  orally 


SMITH-DORSEY  •  a  division  of  The  Wander  Company  •  Lincoln,  Nebraska 


T 

Mo 
inti 

::; 
the 
ill 
thi; 
.:: 


.  :       ■       .,    .; 


\ 


Doctors,  too,  like  "Premarinl' 


The  doctor's  room  in  the  hospital 
is  used  for  a  variety  of  reasons. 
Most  any  morning,  you  will  find  the 
internist  talking  with  the  surgeon, 
the  resident  discussing  a  case  with 
the  gynecologist,  or  the  pediatrician 
in  for  a  cigarette.  It's  sort  of  a  club, 
this  room,  and  it's  a  good  place  to 
get  the  low-down  on  "Premarin" 
therapy. 


If  you  listen,  you'll  learn  not  only 
that  doctors  like  "Premarin,"  but 
why  they  like  it. 

The  reasons  are  fairly  simple. 
Doctors  like  "Premarin,"  in  the  first 
place,  because  it  really  relieves  the 
symptoms  of  the  menopause.  It 
doesn't  just  mask  them  —  it  replaces 
what  the  patient  lacks  —  natural  es- 
trogen. Furthermore,  if  the  patient 


is  suffering  from  headache,  insomnia, 
and  arthritic-like  symptoms  due  to 
estrogendeficiency,"Premarin"takes 
care  of  that,  too. 

"Premarin,"  conjugated  estrogens 
(equine),  is  available  as  tablets  and 
liquid,  and  also  in  combination  with 
meprobamate  or  methyltestosterone. 
Ayerst  Laboratories  •  New  York 
16,  N.  Y.  •  Montreal,  Canada 


What's  she  doing  that's  of  medical  interest? 


5  drinking  a  glass  of  pure  Florida 
ge  juice.  And  that's  important  to 
physician  for  several  reasons. 
ow  your  patients  obtain  their  vita- 
:  or  any  of  the  other  nutrients  found 
trus  fruits  is  of  great  medical  inter- 
■  considering  the  fact  there  are  so 
y  wrong  ways  of  doing  it,  so  many 
titutes  and  imitations  for  the  real 

g- 

ctually,  there's  no  better  way  for 
young  lady  to  obtain  her  vitamin  C 
i  by  doing  just  what  she  is  doing, 


for  there's  no  better  source  than  oranges 
and  grapefruit  ripened  in  the  Florida 
sunshine.  There's  no  substitute  for  the 
result  of  nature's  own  mysterious  chem- 
istry, flourishing  in  the  warmth  of  this 
luxurious  peninsula. 

An  obvious  truth,  you  might  say,  but 
not  so  obvious  to  the  parents  of  many 
teen-agers. 

We  know  that  a  tall  glass  of  orange 
juice  is  just  about  the  best  thing  they 
can  reach  for  when  they  raid  the  refrig- 
erator. We  also  know  that  if  you  en- 


courage this  refreshing  and  healthful 
habit  among  your  young  patients  —  and 
for  that  matter,  your  patients  of  any  age 
—  you'll  be  helping  them  to  the  finest 
between-meals  drink  there  is. 

Nothing  has  ever  matched  the  quality 
of  Florida  citrus— watched  over  as  it 
is  by  a  State  Commission  that  enforces 
the  world's  highest  standards  for  quality 
in  fresh,  frozen,  canned  or  cartoned 
citrus  fruits  and  juices. 

That's  why  the  young  lady's  activities 
are  of  medical  interest. 

©Florida  Citrus  Commission,  Lakeland,  Florida 


in  premenstrual  tension 

only 
treats  the  whole  syndrome 


o  Bromth 


It  was  the  introduction  of  neo  Bromth  several  years  ago  that  created  such  widespread 
interest  in  the  premenstrual  syndrome — because  of  neo  Bromth's  specific  ability 
to  prevent  the  development  of  the  condition  in  the  first  place. 

The  action  of  neo  Bromth  is  not  limited  merely  to  control  of  abnormal  water  retention, 
or  of  nervousness,  or  of  pain — or  any  other  single  or  several  of  the  multiple 
manifestations  characteristic  of  premenstrual  tension,  neo  Bromth  effectively  controls 
the  whole  syndrome. 

neo  Bromth  is  also  completely  free  from  the  undesirable  side  effects  associated  with 
such  limited-action  therapy  as  ammonium  chloride,  hormones,  tranquilizers  and  potent 
diuretics,  neo  Bromth  has  continued  to  prove  to  be  the  safest — as  well  as  the  most 
effective — treatment  for  premenstrual  tension. 

Each  80  mg.  tablet  contains  50  mg.  Pamabrom,  and  30  mg.  pyrilamine  maleate. 
Dosage  is  2  tablets  twice  daily  (morning  and  night)  beginning  5  to  7  days  before 
menstruation.  Discontinue  when  the  flow  starts. 

BRAYTEN   PHARMACEUTICAL   COMPANY   .  Chattanooga  9,  Tennessee 


m 


NEW  For  the 

multi-system  disease 

HYPERTENSION 


"  — nuiA 


Hydroflumethiazide     •     Reserpine     •     Protoveratrine  A 


UTEf 


In  each  SALUTENSIN  Tablet: 
Saluron®  (hydroflumethiazide)  — 

a  saluretic-antihypertensive  50  mg. 

Reserpine  — a  tranquilizing  drug  with 

peripheral  vasorelaxant  effects  0.125  mg. 

Protoveratrine  A  —  z  centrally  mediated 

vasorelaxant 0.2  mg. 


An  integrated  multi-therapeutic 
antihypertensive,  that  combines  in  balanced  pro- 
portions three  clinically  proven  antihypertensives. 

Comprehensive  information  on  dosage  and  precautions 
in   official    package   circular   or  available   on   request. 

BRISTOL  LABORATORIES     •     Syracuse,  New  York 


September,  1960 


ADVERTISEMENTS 


XXVII 


Following  determination 
of  basal  secretion, 
intragastric  pH  was 
continuously  determined 
by  means  of  frequent 
readings  over  a 
two-hour  period. 

PH  Data  based  on  pH  measurements  in  11  patients  with  peptic  ulcer* 


4.9 


Neutralization 
with  new  Creamalin 


4.5 


3.S  i ; 


3.0 


2.5 


i   J 

A                                3-5 

1 

Neutralization                          \ 
with  standard 
aluminum  hydroxide 

^^3.1 

"\2.0 

m  neutralization 
is  much 
faster  and 
twice 
as  long 
with 


Minutes  20 


60 


80 


120 


■"  CREAMALIN  ANTAC,° 


LABORATORIES  ■ 
New  York  18,  N.  Y. 


TABLETS 


New  proof  in  vivo'  of  the  much  greater  efficacy  of  new  Creamalin 
tablets  over  standard  aluminum  hydroxide  has  now  been  ob- 
tained. Results  of  comparative  tests  on  patients  with  peptic  ulcer, 
measured  by  an  intragastric  pH  electrode,  showthat  newCreamalin 
neutralizes  acid  from  40  to  65  per  cent  faster  than  the  standard 
preparation.  This  neutralization  (pH  3.5  or  above)  is  maintained 
for  approximately  one  hour  longer. 

New  Creamalin  provides  virtually  the  same  effects  as  a  liquid 
antacid2  with  the  convenience  of  a  tablet. 
Nonconstipating  and  pleasant-tasting,  new  Creamalin  antacid 
tablets  will  not  produce  "acid  rebound"  or  alkalosis. 
Each  new  Creamalin  antacid  tablet  contains  320  mg.  of  specially 
processed,  highly  reactive,  short  polymer  dried  aluminum  hy- 
droxide gel  (stabilized  with  hexitol)  with  75  mg.  of  magnesium 
hydroxide.  Minute  particles  of  the  powder  offer  a  vastly  increased 
surface  area  for  quicker  and  more  complete  acid  neutralization. 

Dosage:  Gastric  hyperacidity —  from  2  to  4  tablets  as  necessary.  Peptic 
ulcer  or  gastritis  —  from  2  to  4  tablets  every  two  to  four  hours.  Tablets  may 
be  chewed,  swallowed  whole  with  water  or  milk,  or  allowed  to  dissolve 
in  the  mouth.  How  supplied:  Bottles  of  50,  100,  200  and  1000. 
1.  Data  in  the  files  of  the  Department  of  Medical  Research,  Winthrop 
Laboratories.  2.  Hinkel,  E.  T.,  Jr.;  Fisher,  M.  P.,  and  Tainter,  M.  L.:  J.  Am. 
Pharm.  A.  (Scient.  Ed.)  48:384,  July,  1959. 

for  peptic  ulcere  gastritis*  gastric  hyperacidity 


Sometimes, 
when  I  have 
a  running  nose, 
I'd  like  to 
clear  it  with 

TRIAMINIC^ 
just  to  check  out 
that  systemic 
absorption  business. 

Reaches  all  nasal 
and  paranasal 
membranes,  huh?" 


. .  .  and  for  humans  ^  ou  can't  reach  the  entire  nasal  and  paranasal  mucosa  by  putting 

medication  in  a  man's  nostrils  —  any  more  than  you  could  by  trying  to 
With  pour  it  down  an  elephant's  trunk.  TRIAMINIC,  by  contrast,  reaches  all 

:?TTN"MT'Nrr    "NTOCJTT  Q  respiratory  membranes  systemicaMy  to  provide  more  effective,  longer- 

lasting  relief.  And  TRIAMINIC  avoids  topical  medication  hazards  such 
as  ciliary  inhibition,  rebound  congestion,  and  "nose  drop  addiction." 

Judications:  nasal  and  paranasal  congestion,  sinusitis,  postnasal  drip, 
upper  respiratory  allergy. 

ielief  IS  prompt  and  prolonged  Each    Triaminic  timed-release   Tablet  provides: 

because  of  this  special  timed-release  action:  Phenylpropanolamine  hci  .  .50  mg. 

Pheniramine  maleate   2o  mg. 

Pyrilamine  maleate 25  mg. 

first—  the  outer  laver  Dosage:  1  tablet  in  the  morning,  midafternoon  and  at  bedtime, 

dissolves  within  '  'n  Postnasa'  drip,  1  tablet  at  bedtime  is  usually  sufficient. 

minutes  to  produce  Each  timed-release  Triaminic  Juvelet®  provides: 

3  to  4  hours  of  relief  ,,    .,      -  ...  .  ,,     _  .  „  ,,   . 

\z  the  formulation  of  the  Triaminic  Tablet. 

then—  the  core  Dosage:  1  Juvelet  in  the  morning,  midafternoon  and  at  bedtime. 

disintegrates  to  „     ,    .         ,„  ,  ,      ,  m   .       .    .     0  .  , 

give  3  to  4  more  '       tsp'  ^5  ""•'  o)   Tr'aml>uc  Syrup  provides: 

hours  of  relief  ''  tne  i°rm"lation  of  the  Triaminic  Tablet. 

Dosage  (to  be  administered  every  3  or  4  hours)  : 

Adults  —  1  or2  tsp.;  Children  «  to  12-  1  tsp.; 

Children  1  to  6  —  Vi  tsp.;  Children  under  1  —  Vt  tsp. 

J-    -L  \j  -L  ^»  A.  -L V -1_  X  i.   i    JL  V»y      timed-release  tablets,  jtii'elets,  and  syrup 
j|  running  noses  ^t-,    ^^  an<^  °Pen  stuffed  noses  orally 


SMITH-DORS EY  •  a  division  of  The  Wander  Company  •  Lincoln,  Nebraska 


September,  1960 


ADVERTISEMENTS 


XXIX 


ALL  OVER  AMERICA! 

KENTwiththe  MICRONITE  FILTER 

IS  SMOKED  BY 
MORE  SCIENTISTS  and  EDUCATORS 

than  any  other  cigarette!* 


FIVE 

TOP 

BRANDS 

OF 

CIGARETTES 

SMOKED 

BY  AMERICAN 

SCIENTISTS 

KENT. 

15.3% 

BRAND  "A"  1 
BRAND  "G    c 

10.5% 
7.9% 

BRAND    F    a 

7.6% 

BRAND  "B 

7.3% 

FIVE  TOP  BRANDS  OF  CIGARETTES 
SMOKED  BY  AMERICAN   EDUCATORS 

KENT  ■■■■■■■■■■■.^■■■^■^■■■■■H  20.2% 

BRAND  "G    KiwMaeffi  6.0% 

BRAND  "E'  S3KS5s*sssss*sas  7.7% 

BRAND  "A"  mwH— M  7.7% 

BRAND  "F"  ■"! "■— .»  7.0% 


This  does  not  constitute  a 
professional  endorsement 
of  Kent.  But  these  men,  like 
millions  of  other  Kent  smokers, 
smoke  for  pleasure,  and  choose 
their  cigarette  accordingly. 


The  rich  pleasure  of  smoking 
Kent  comes  from  the  flavor 
of  the  world's  finest  natural 
tobaccos,  and  the  free  and 
easy  draw  of  Kent's  famous 
Micronite  Filter. 


If  you  would  like  the  booklet,  "The  Story  of  Kent",  for  your 
own  use,  write  to:  P.  Lorillard  Company  — Research  De- 
partment, 200  East  42nd  Street,  New  York  17,  New  York. 

For  good  smoking  taste, 
it  makes  good  sense  to  smoke 

;fc  Results  ot  a  continuing  study  of  cigarette  preferences,  conducted  by  O'Brien  Sherwood  Associates,  N  Y.,  NY. 
A  PRODUCT  OF  P  LORILLARD  COMPANY    FIRST  WITH  THE  FINEST  CIGARETTES    THROUGH   LORiLLARD  RESEARCH 


I0-S1II. 
IEOULAI    Sill 

Ol   Crush   PIOOF   lot 


C  i«o,  f.  iowuasd  CO. 


You  see  an  improve- 
ment within  a  few  days 
Thanks  to  your  prompt 
treatment  and  the 
smooth  action  of  Deprol, 
her  depression  is 
relieved  and  her  anxiety 
and  tension  calmed  — 
often  in  a  few  days.  She 
eats  well,  sleeps  well 
and  soon  returns  to  her 
normal  activities. 


4\ 


Lifts  depression. ..as  it  calms  anxiety! 

Smooth,  balanced  action  lifts  depression  as 
it  calms  anxiety. . .  rapidly  and  safely 


Balances  the  mood  —  no  "seesaw"  effect 
of  amphetamine -barbiturates  and  ener- 
gizers.  While  amphetamines  and  energizers  may 
stimulate  the  patient  —  they  often  aggravate 
anxiety  and  tension. 

And  although  amphetamine-barbiturate  combina- 
tions may  counteract  excessive  stimulation  —  they 
often  deepen  depression. 

In  contrast  to  such  "seesaw"  effects,  Deprol's 
smooth,  balanced  action  lifts  depression  as  it  calms 
anxiety  —  both  at  the  same  time. 


Dosage:  Usual  starting  dose  is  1  tablet 
q.i.d.  When  necessary,  this  dose  may  be  grad- 
ually increased  up  to  3  tablets  q.i.d. 

Composition:  1  mg.  2-diethylaminoethy]  benzi- 
late  hydrochloride  tbenactyzine  HC1I  and  400  mg. 
meprobamate.  Supplied:  Bottles  of  50  light-pink, 
scored   tablets.  Write   for  literature  and  samples. 


Acts  swiftly— the  patient  often  feels 
better,  sleeps  better,  within  a  few  days. 

Unlike  the  delayed  action  of  most  other  antide- 
pressant drugs,  which  may  take  two  to  six  weeks 
to  bring  results,  Deprol  relieves  the  patient  quickly 
—often  within  a  few  days.  Thus,  the  expense  to  the 
patient  of  long-term  drug  therapy  can  be  avoided. 

Acts  safely  —  no  danger  of  liver  damage. 

Deprol  does  not  produce  liver  damage,  hypoten- 
sion, psychotic  reactions  or  changes  in  sexual 
function  — frequently  reported  with  other  anti- 
depressant drugs. 


ADeprol 


A® 


WALLACE  LABORATORIES/AVw  Brunswick,  N.  J. 


who coughed? 


u 


WHENEVER  COUGH  THERAPY 
IS  INDICATED 

HYCOMINE 


Syrup 


cough  sedative  /  antihistamine 
decongestant  /  expectorant 


THE  COMPLETE  Rx 
FOR  COUGH  CONTROL 


relieves  cough  and  associated  symptoms  in  15-20 
minutes  ■  effective  for  6  hours  or  longer  ■  pro- 
motes expectoration  ■  rarely  constipates  ■  agree- 
ably cherry-flavored 

Each  teaspoonful  (5  cc.)  of  Hycomine*  Syrup  contains: 
Hycodan® 

Dihydrocodeinone  Bitartrate 5  mg."| 

(Warning:  May  be  habit-forming)  >    6.5  mg. 

Homatropine  Methylbromide 1.5  mg.j 

Pyrilamine  Maleate 12.5  mg. 

Phenylephrine  Hydrochloride 10  mg. 

Ammonium  Chloride 60  mg. 

Sodium  Citrate 85  mg. 

Average  adult  dose:    One  teaspoonful  after  meals  and  at  bedtime. 
May  be  habit-forming.  Federal  law  permits  oral  prescription. 

Literature  on  request 

ENDO  LABORATORIES 

Richmond  Hill  18,  New  York 

,     ?U.S.  Pat.  2,630.400 


Dimetane 


i  distinguished  by  its 
'. .  .very  low  incidence  of 
undesirable  side  effects . .  ."* 


■ 


HIHIHI 


9amt 


even  m 
allergic 
infants 


FROM  A  CLINICAL  STUDY*  IN  ANNALS  OF  ALLERGY 


Patients 

200  infants  and  children,  ages  2  months  to  14  years 

Diagnosis 

Perennial  allergic  rhinitis 

Therapy 

Dimetane  Elixir 

Results 

in  149,  good  results  /  in  40,  fair  results 

Side  Effects 

Encountered  in  only  7  patients  (in  all  except  one, 
the  side  effect  was  mild  drowsiness) 

\ 


■ 


In  allergic  patients  of  all  ages,  Dimetane  has  been  shown  to  work  with  an  effec- 
tiveness rate  of  about  90%  and  to  produce  an  exceptionally  low  incidence 
of  side  effects.  Complete  clinical  data  are  available  on  request  to  the  Medical 
Department.  Supplied:  dimetane  Hxientabs  (12  mg.),  Tablets  l§^tfttt^: 
(4  mg.),  Elixir  (2  mg./5  cc),  new  dimetane-ten  Injectable  (l^Sfl^aR 
(10  mg./cc.)  or  new  dimetane-100  Injectable  (100  mg./cc).   '/Sl^SMA 


NNALS   OF  ALLEROY  17:913,  1951). 


A.  H.  ROBINS  CO.,  INC.,  RICHMOND  20,  VIRGINIA/ETHICAL  PHARMACEUTICALS  OF  MERIT  SINCE  1878 

t  PARABROMDYLAMINE  MALEATE 


3 


>  -yv 


Ai 


ACUTE  BRONCHITIS 


SYNCILLIN 

250  mg.  t.i.d.  -  6  days 


H.F.  45-year-old  white  female.   First  seen  on 
Aug.  24,  1959  with  acute  bronchitis  of  3  days1 
duration.   Culture  of  the  sputum  revealed  alpha 
hemolytic  streptococci.   A  250  mg.  SYNCILLIN 
tablet  was  administered  3  times  daily.   Another 
sputum  culture  taken  on  Aug.  27  showed  no  growth. 
On  Aug.  30,  the  patient  appeared  much  improved 
and  SYNCILLIN  was  discontinued. 
Recovery  uneventful.  -  *k 


Actual  case  summary  from  the  files  of  Bristol  Laboratories'  Medical  Department 


THE  ORIGINAL  potassium  phenethicillin 


SYNCILLIN 

(Potassium  Penicillin- 152) 
A  dosage  form  to  meet  the  individual  requirements  of  patients  of  all  ages  in  home,  office,  clinic,  and  hospital : 

Syncillin  Tablets  -  250  mg.  (400,000  units) . . .  Syncillin  Tablets  -  125  mg.  (200,000  units) 

Syncillin  for  Oral  Solution  -  60  ml.  bottles  -  when  reconstituted,  125  mg.  (200,000  units)  per  5  ml. 

Syncillin  Pediatric  Drops  -  1.5  Gm.  bottles.  Calibrated  dropper  delivers  125  mg.  (200,000  units) 

Complete  information  on  indications,  dosage  and  precautions  is  included  in  the  circular  accompanying  each  package. 


BRISTOL  LABORATORIES,  SYRACUSE,  NEW  YORK  (jWroi 


XXXI  V 


NORTH  CAROLINA  MEDICAL  JOURNAL 


September,  1960 


experience 
dictates 
V-CILLIN  K 


fOr  maximum  effeCtiVeneSS  Recently,  Griffith'  reported  that  V-Cillin 
K  produces  antibacterial  activity  in  the  serum  against  penicillin-sensitive  patho- 
gens which  is  unsurpassed  by  any  other  form  of  oral  penicillin.  This  helps  explain 
why  physicians  have  consistently  found  that  V-Cillin  K  gives  a  dependable 
clinical  response. 

fOr  Unmatched  Speed  Peak  levels  of  antibacterial  activity  are  attained 
within  fifteen  to  thirty  minutes — faster  than  with  any  other  oral  penicillin.1 

fOr  UnSUrpaSSed  Safety  The  excellent  safety  record  of  V-Cillin  K  is 
well  established.  There  is  no  evidence  available  to  show  that  any  form  of  peni- 
cillin is  less  allergenic  or  less  toxic  than  V-Cillin  K. 

Prescribe  V-Cillin  K  in  scored  tablets  of  125  and  250  mg.,  or  V-Cillin  K,  Pediatric, 
in  40  and  80-cc.  bottles. 

1.  Griffith,  R.  S.:  Comparison  of  Antibiotic  Activity  in  Sera  Following  the  Administration  of 
Three  Different  Penicillins,  Antibiotic  Med.  &  Clin.  Therapy.  7:No.  2  (February),  1960. 

V-CILLIN  K®  (penicillin  V  potassium,  Lilly) 


ELI      LILLY    AND     COMPANY 


INDIANAPOLIS     6,     INDIANA,     U.S.A. 

033CO1 


North  Carolina  Medical  Journal 

Owned  and  Published  by 
The  Medical  Society  of  the  State  of  North  Carolina 


Volume  21 


September,  1960 


No.  9 


Meeting  North  Carolina's  Occupational  Health  Needs 
Through  Our  State  Agencies 


Emil  T.  Chanlett* 
Chapel  Hill 


In  our  occupational  pursuits,  there  are 
two  important  standards  of  measurement. 
One  is  external — that  of  productivity.  The 
other  is  internal — that  of  personal  gratifi- 
cation, as  we  seek  to  be  worthy  of  our  own 
self-esteem  and  the  esteem  of  those  who  work 
and  live  with  us.  In  this  process  importance 
of  physical  and  mental  well-being  is  so  ob- 
vious that  one  wonders  why  so  little  con- 
certed study  has  been  directed  to  the  rela- 
tionship between  occupation  and  health.  We 
are  all  aware  of  our  individual  efforts  in  this 
matter  and  may  even  take  some  pride  in  our 
accomplishments.  The  particular  business  of 
this  Occupational  Health  Council  is  to  con- 
sider how  we  may  direct  our  efforts  in  con- 
cert, with  a  reasonable  expectation  of  larger 
benefits  and  greater  returns  through  our  in- 
tegrated strength. 

A  variety  of  definitions  have  been  pro- 
posed for  occupational  health,  and  many  of 
these  are  useful.  The  intuitive  concept  of 
the  term  is  accurate.  Concretely,  it  means 
that  employees  and  employers  in  good  health 
enjoy  fatter  pay  checks,  more  efficient  pro- 
duction, and  larger  profits.  Therefore,  a  mat- 
ter of  such  importance  merits  the  expendi- 
ture of  time,  thought,  and  money. 

The  factors  making  for  good  or  bad  health 
at  work  are  much  the  same  as  those  operat- 
ing elsewhere,  although  they  may  differ  in 
character  and  intensity.  There  are  accidents. 
There  is  exposure  to  poisonous  gases,  vapors, 
dusts,  and  fumes;  to  unusual  forms  of  phy- 
sical energy  such  as  radiation,  noise,  heat, 
and  light.  There  is  exposure  to,  and  contrac- 
tion of,  communicable  diseases.  There  is  the 
degeneration  or  loss  of  full  physiologic  func- 
tion of  our  various  organs  and  members,  in- 


♦Professor    of     Sanitary     Engineering,     the     School     of     Public 
Health,    University    of    North    Carolina.    Chapel    Hill. 


eluding  our  skin.  There  are  the  manifold  in- 
fluences that  determine  our  feelings  and 
modes  of  adaptation,  which  have  much  to  do 
with  our  effectiveness  and  our  happiness.  All 
these  factors  are  the  concern  of  this  Council, 
with  the  exception  of  the  prevention  of  acci- 
dents in  industry.  Comparable  councils  are 
already  dealing  with  accidents  and  aiding 
the  agencies  which  face  the  grim  task  of 
reducing  accident  tolls. 

There  are  four  state  agencies  which  have 
direct  responsibilities  and  functions  in  occu- 
pational health  in  our  state.  Three  deal  with 
the  prevention  and  detection  of  and  the  com- 
pensation for  occupational  diseases.  Por- 
tions of  these  functions  are  allocated  by  sta- 
tute to  the  Department  of  Labor,  the  Indus- 
trial Commission,  and  the  State  Board  of 
Health.  The  fourth  is  concerned  with  the 
salvage  through  vocational  rehabilitation  of 
those  disabled  by  disease  or  injury.  The  Di- 
vision of  Vocational  Rehabilitation  within 
the  State  Board  of  Education  serves  the  vic- 
tims not  only  of  occupational  disabilities,  but 
of  other  misfortunes  as  well.  The  occupa- 
tional health  activities  of  these  agencies  have 
been  substantially  confined  to  the  narrow 
front  of  occupational  disease  control.  This  is 
in  keeping  with  our  North  Carolina  statutes 
and  the  codes  and  rules  made  under  them 
which  are  explicit  with  regard  to  specific 
functions  of  three  of  the  agencies.  A  brief 
review  of  their  powers  and  functions  will  be 
useful. 

Department  of  Labor 

Our  Labor  Department  has  the  powers  of 
inspection,  enforcement,  and  prosecution  un- 
der all  laws  relating  to  conditions  of  work. 
These  include  rule-making  powers  pertain- 
ing to  accidents  and  occupational  diseases. 
Rules  have  been  promulgated  relating  to  all 


358 


NORTH   CAROLINA   MEDICAL  JOURNAL 


September,   1960 


industries  and  to  particular  places  of  work, 
including  requirements  for  adequate  exhaust 
ventilation  systems  to  remove  dust,  gases, 
and  fumes  known  to  be  capable  of  producing 
occupational  diseases.  The  Labor  Depart- 
ment also  regulates  matters  of  cleanliness, 
sanitary  facilities,  lighting,  and  air-condi- 
tioning. 

The  Labor  Department's  contribution  in 
the  area  of  occupational  disease  and  the 
broader  field  of  occupational  health  has  been 
to  provide  legal  enforcement  when  and  where 
needed.  Its  field  staff  has  provided  educa- 
tional material  to  employers  and  employee 
groups,  and  has  collaborated  in  special 
courses  for  supervisory  personnel  and  those 
particularly  concerned  with  safety  and 
health.  In  its  series  of  industrial  safety 
courses  conducted  in  cooperation  with  North 
Carolina  State  College,  the  environmental 
phases  of  occupational  disease  control  have 
received  attention. 

The  field  staff  of  safety  supervisors  and 
inspectors  of  the  Labor  Department  have 
provided,  through  their  observation  during 
routine  visits,  many  leads  on  hazardous  situ- 
ations capable  of  producing  occupational  dis- 
ease. These  have  been  referred  to  the  staff 
of  the  State  Board  of  Health  for  study  and 
recommendations.  The  Department's  activi- 
ties, although  directed  primarily  to  the  pre- 
vention of  accidents,  has  prepared  the 
groundwork  among  employers  and  employees 
for  a  better  understanding  of  their  joint  re- 
sponsibilities for  health  and  safety. 

Indiistrial  Com  mission 

All  of  us  are  familiar  with  the  over-all  re- 
sponsibilities of  the  Industrial  Commission, 
an  autonomous  administrative  agency  with- 
in the  Labor  Department.  Its  responsibili- 
ties for  occupational  health  are  clearly  de- 
fined in  terms  of  occupational  diseases.  This 
agency  is  responsible  for  the  adjudication  of 
compensation  claims  arising  from  any  of  the 
specifically  stated  26  causes  or  conditions 
capable  of  producing  occupational  disease. 
In  compensation  law  our  North  Carolina  act 
is  referred  to  as  a  scheduled  coverage  of  oc- 
cupational diseases,  as  claims  may  be  made 
only  for  the  causes  or  conditions  stated  in 
the  law.  The  Industrial  Commission  has  had 
a  particular  concern  for  claims  arising  from 
silicosis  and  asbestosis,  as  these  conditions 
had  much  to  do  with  the  creation  of  our  com- 
pensation law.    The  statute  creating  the  In- 


dustrial Commission  requires  the  reporting 
of  occupational  disease,  and  provides  for  a 
medical  advisory  committee  to  assist  in  eval- 
uating cases  and  for  determining  the  fitness 
of  employees  for  work  in  the  dusty  trades. 

The  Industrial  Commission  has  faithfully 
administered  our  compensation  law,  includ- 
ing the  orderly  and  rapid  processing  of 
claims  arising  from  occupational  diseases 
with  a  continued  emphasis  and  stress  upon 
the  diseases  arising  in  the  dusty  trades.  The 
staff  of  the  Commission  has  provided  safety 
instruction,  through  organized  classes, 
through  its  publications,  and  through  the 
promotion  of  the  Annual  State-Wide  Safety 
Conference.  In  all  these  media,  the  import- 
ance of  occupational  diseases  as  a  cause  of 
disability  and  death  has  received  compelling 
attention. 

The  Industrial  Commission  is  an  indis- 
pensable and  valuable  source  of  statistical 
data  on  the  cases,  claims,  disabilities,  and 
deaths  arising  from  occupational  diseases, 
and  on  the  direct  cost  which  these  impose 
upon  us  all.  A  by-product  of  one  of  its  stud- 
ies of  factors  contributing  to  industrial  ac- 
cidents is  new  knowledge  on  the  importance 
of  healthful  living  to  the  efficiency  and  hap- 
piness of  employees.  A  staff  study  has  shown 
that  the  sort  of  breakfast  eaten  and  how  a 
weekend  is  spent  influence  the  frequency  and 
time  of  occurrence  of  industrial  accidents. 
These  observations  recently  captured  nation- 
wide attention.  It  was  certainly  an  interest- 
ing hint  of  the  potential  that  we  have  for 
working  together  in  occupational  health. 

Division  of  Vocational  Rehabilitation 
The  Division  of  Vocational  Rehabilitation 
has  the  function  of  renewing  people  for  em- 
ployment who  have  been  disabled,  through 
any  means,  in  any  place,  or  under  any  con- 
ditions. Its  services  are  not  restricted  to 
those  whose  disability  has  been  incurred  in 
the  course  of  employment.  Working  coop- 
eratively with  a  federal  agency,  this  organi- 
zation provides  services  for  the  disabled 
which  embrace  medical  repair,  counsel,  guid- 
ance and  training,  and  assistance  in  finding 
a  new  and  productive  place  in  our  society. 
It  is  a  process  of  restoration  which  pays  rich 
dividends  in  self-respect  and  in  lightening 
the  community's  cost  for  carrying  the  un- 
fortunate. 

State  Board  of  Health 
Our   State  Board   of  Health   has   general 
as  well  as  specific  powers  and  responsibili- 


September,  1960 


MEETING   OCCUPATIONAL   HEALTH   NEEDS— CHANLETT 


359 


ties  with  regard  to  occupational  health.  Un- 
der its  general  powers  relating  to  health  and 
sanitary  conditions,  the  power  to  investigate 
the  effect  of  employment  upon  the  public 
health  is  specifically  mentioned. 

The  Occupational  Health  Section  of  the 
State  Board  of  Health,  formerly  known  as 
the  Division  of  Industrial  Hygiene,  is  desig- 
nated as  the  technical  and  professional  agent 
of  the  Industrial  Commission  for  the  detec- 
tion and  prevention  of  occupational  diseases 
and  for  medical  advice  in  the  adjudication 
of  claims.  Although  its  activities  have  been 
closely  related  to  the  needs  of  the  Industrial 
Commission,  the  Occupational  Health  Sec- 
tion is  an  integral  part  of  the  State  Board 
of  Health.  A  small  group  of  specialized  per- 
sonnel was  originally  made  possible  through 
federal  funds  to  which  this  state  was  entitled 
under  the  Social  Security  Act.  Federal  as- 
sistance continues,  although  there  is  now 
substantial  support  from  the  state.  The  staff 
presently  consists  of  a  medical  director,  an 
industrial  nurse,  two  industrial  hygiene  en- 
giners,  two  industrial  hygienists,  x-ray  tech- 
nicians, and  secretarial  personnel. 

This  group  directly  serves  the  dusty  trades 
by  providing  x-ray  examinations  of  all  em- 
ployees exposed  to  silica  or  asbestos  dust, 
with  further  physical  evaluation  when 
needed.  A  physician  supplies  medical  infor- 
mation for  compensation  hearings  through 
reports,  affidavits,  and  even  direct  testimony 
when  required.  A  field  engineering  staff  car- 
ries out  an  extensive  schedule  of  air-samp- 
ling to  determine  dust  concentration  where 
silica  or  asbestos  are  present.  This  same 
group  makes  recommendations  for  dust  con- 
trol by  appropriate  engineering  methods 
such  as  ventilation,  isolation,  and  wetting. 

In  spite  of  the  fact  that  the  direct  services 
rendered  the  dusty  trades  make  heavy  de- 
mands on  the  time  and  funds  of  the  small 
staff,  the  group  has  provided  medical  and 
engineering  services  as  well  as  air-sampling 
in  all  instances  of  known  or  suspected  cases 
of  occupational  disease  which  have  been 
brought  to  its  attention.  Requests  for  such 
services  arise  from  the  Industrial  Commis- 
sion, the  Labor  Department,  the  North  Caro- 
lina Rating  Bureau,  from  industrial  man- 
agement and  employee  groups,  and  occa- 
sionally from  local  health  departments. 
There  have  been  numerous  field  studies  of 
exposure  to  such  notorious  toxic  substances 
as  lead,  benzol,  zinc  oxide,  vapors  of  paint 
solvents,  and  exposure  to  radiation  from  ra- 


dium, polonium,  and  radioisotopes.  There  is 
liaison  with  the  U.  S.  Atomic  Energy  Com- 
mission when  the  latter  inspects  licensed 
users  of  AEC  material  in  North  Carolina. 

The  professional  engineering  staff  of  the 
Occupational  Health  Service  has  initiated 
survey  studies  on  such  matters  as  x-ray  shoe- 
fitting  machines,  x-ray  and  fluoroscopic  ma- 
chines used  in  health  departments,  hospitals, 
and  physicians'  offices ;  on  exposure  to  sol- 
vent vapors  in  the  furniture  industry;  and 
on  carbon  monoxide  from  heating  devices  in 
motels  and  tourist  cabins.  This  staff  has  pro- 
vided consultant  service  on  exhaust  ventila- 
tion for  the  control  of  toxic  vapors,  gases, 
fumes,  and  dusts.  Such  service  has  reached 
plants  in  many  parts  of  our  state,  with  much 
of  it  directed  to  smaller  organizations  which 
did  not  have  ready  access  to  technical 
knowledge. 

The  one  area  in  which  the  activities  of  the 
Occupational  Health  Section  of  the  State 
Board  of  Health  have  not  been  directly  ori- 
ented to  occupational  disease  prevention  and 
control  is  that  of  consultation  to  industrial 
nurses.  This  activity  was  limited  in  scope, 
time,  and  geography  until  the  present  year. 
Until  1958  it  was  carried  on  by  a  nurse 
stationed  in  Asheville  who  could  only  devote 
part  of  her  time  in  industrial  nursing  activi- 
ties. Beginning  this  year,  a  competent,  full- 
time  nurse  is  assigned  directly  to  the  Occu- 
pational Health  Section  and  is  giving  a  wider 
coverage  to  the  some  225  industrial  nurses 
employed  in  North  Carolina,  as  well  as  con- 
sultation to  establishments  which  are  consid- 
ering employing  a  nurse  for  the  benefit  of 
their  employees.  This  is  looked  to  as  a  happy 
sign  of  occupational  health  activities  yet  to 
come. 

Limitations  and  Problems 

Within  the  limitations  imposed  upon  them, 
these  organizations  have  served  the  state  ad- 
mirably, and  have  cooperated  with  one  an- 
other spontaneously  and  well.  The  limita- 
tions are  not  only  budgetary ;  some  are  statu- 
tory. Many  arise  from  the  multitudinous  du- 
ties imposed  on  the  heads  of  departments 
and  divisions,  depriving  them  of  time  for 
thoughtful,  creative  development  of  inter- 
agency planning  in  the  realm  of  occupational 
health.  This  has  resulted  in  activities  which 
are  limited  and  late.  This  sketchy  review  in- 
dicates that  action  has  been  substantially 
limited  to  occupational  disease.  Even  in  that 
instance  It  has  been  late  in  the  sense  that 


3C0 


NUKTH    CAROLINA    MEDICAL  JOURNAL 


Septeml> 


1960 


time  and  energy  spent  in  prevention  are  out 
of  proportion  to  the  time,  energy  and  money 
spent  in  repairing  the  damage  which  has  al- 
ready been  inflicted. 

The  wisdom  of  prevention  rather  than  cure 
becomes  more  apparent  if  we  translate  the 
concept  into  that  of  a  tangible  product  of 
our  industry.  Such  sound  management  prac- 
tices as  quality  control,  preventive  mainte- 
nance on  machinery,  and  adherence  to  speci- 
fications of  raw  materials  cut  down  the  num- 
ber of  costly  production  "lemons."  Repair- 
ing, recouping,  and  paying  off  claims  for  pro- 
duction "lemons"  that  have  found  their  way 
to  the  market  place  is  a  poor  investment  of 
the  production  dollar.  Similarly,  however  ad- 
mirable and  needful  they  may  be,  payments 
for  hospital  care,  rehabilitation,  and  com- 
pensation claims  are  poor  investments  of  the 
health  dollar  as  long  as  any  path  of  preven- 
tion has  been  left  unexplored. 

Occupational  diseases  are  the  key  to  the 
broad  problem  of  occupational  health,  for  a 
well  planned,  well  executed  program  of  oc- 
cupational disease  control  is  a  stepping  stone 
to  employer  and  employee  understanding  and 
support  of  an  occupational  health  service. 
As  our  compensation  coverage  of  occupa- 
tional diseases  in  North  Carolina  is  limited 
by  a  scheduled  act,  we  cannot  claim  to  have 
complete  information  on  all  these  conditions. 
For  the  26  specific  causes  and  conditions 
which  are  compensable,  a  review  of  the  10- 
year  period  from  1946  to  1956  reveals  that 
the  compensation  and  medical  care  of  victims 
of  occupational  disease  is  costing  from  $130,- 
000  to  $150,000  per  year,  with  the  loss  of 
7,000  to  7,500  working  days  per  year.  Sta- 
tistical records  of  the  Industrial  Commission 
show  that  the  dusty  trades  are  not  the  sole 
sources  of  claims,  although  the  largest  sums 
for  single  cases  do  arise  from  the  mining  and 
rock-quarrying  industries.  Among  those  pay- 
ing a  heavy  toll  in  lost  time  and  compensa- 
tion claims  are  the  cotton,  woolen,  and  hos- 
iery mills.  The  furniture  and  machinery 
manufacturing  industries  are  also  frequently 
found  among  the  leading  five  payers  of  com- 
pensation claims  and  the  leading  losers  of 
production  days  due  to  occupational  diseases. 

Analysis  of  the  last  five  biennial  reports  of 
the  Industrial  Commission  further  shows 
that  our  occupational  disease  cases  are 
widely  scattered  by  industry  types  and  plant 
size,  and  that  agricultural  pursuits  are  not 
exempt.  A  really  significant  fact  is  that  the 
losses  clue  to  occupational  diseases  are  un- 


necessary. Our  North  Carolina  organizations 
have  the  professional  and  technical  knowl- 
edge and  a  cadre  of  professional  persons  to 
deal  with  the  occupational  disease  problems 
in  North  Carolina  industries. 

Questions   That  Merit   Consideration 

From  these  rather  general  remarks  con- 
cerning the  occupational  health  activities  of 
our  State  agencies,  several  questions  may  be 
drawn  which  merit  the  thoughtful  considera- 
tion of  this  council:  What  is  needed  to  make 
occupational  disease  control  more  effective? 
What  devices  would  help  to  formalize  and 
insure  the  coordination  of  the  activities  of 
the  present  agencies?  Can  our  teaching  hos- 
pitals participate  in  such  services  as  a  diag- 
nostic clinic  for  occupational  diseases?  What 
steps  are  needed  to  increase  the  interest  of 
private  physicians  in  the  occurrence  of  occu- 
pational diseases  among  the  breadwinners 
of  the  families  they  now  serve?  What  forms 
of  employer  and  employee  education  on  oc- 
cupational disease  hazards  and  their  control 
are  most  certain  of  acceptance  and  success? 

Beyond  the  matter  of  occupational  disease 
control,  there  is  evidence  of  relatively  little 
governmental  promotion  of  industry  sup- 
ported health  services.  This  raises  questions 
for  which  answers  may  be  neither  quick  nor 
easy.  What  steps  are  needed  to  encourage 
management,  workers,  and  doctors  to  under- 
take a  coordinated  effort  to  raise  the  level 
of  occupational  health  in  our  state?  What 
increases  must  be  made  in  the  staffs  of  our 
state  agencies  if  they  are  to  exercise  leader- 
ship and  be  of  practical  help,  particularly 
to  our  smaller  plants?  What  steps  can  be 
taken  to  mobilize  the  potential  contributions 
which  local  health  departments  and  com- 
munity hospitals  are  capable  of  making  to 
the  maintenance  of  a  higher  level  of  health 
among  the  most  important  person  in  their 
communities — the  wage  earners? 

It  is  certain  that  these  questions,  incom- 
plete and  poorly  framed,  have  already  raised 
many  new  ones  in  your  minds.  As  these  or 
others  like  them  are  discussed,  their  com- 
plexity should  be  neither  frustrating  nor  dis- 
couraging. They  are  the  daily  business  of 
many  of  us.  They  are  matters  of  economic 
necessity  which  must  be  met  by  sound  man- 
agement practices. 

Conclusion 

It  has  been  demonstrated  in  the  experi- 
ences of  plants  throughout  our  country,  and 


September,  1960 


MEETING    OCCUPATIONAL   HEALTH   NEEDS— CHANLETT 


361 


in  some  in  our  own  state,  that  well  planned 
occupational  health  work  will  reduce  absen- 
teeism, reduce  insurance  costs,  and  make  for 
higher  morale  and  more  efficient  production. 
Our  Governor  has  repeatedly  expressed  his 
conviction  that  occupational  health  is  vital 
to  the  economic  progress  of  our  state.  The 
work  of  this  council  will  certainly  contribute 
to  our  state  drive  for  an  increase  in  indus- 
trial plants  and  for  a  greater  diversification 
of  our  agriculture.  A  productive  occupa- 
tional health  program  will  reduce  our  labor 
turnover,   and  will  encourage  more  of  our 


best  trained  workers  to  stay  in  North  Caro- 
lina. This  council  is  the  platform  upon  which 
to  develop  a  cooperative  effort  in  occupa- 
tional health  among  employers,  employees, 
state  and  local  governmental  agencies,  and 
the  several  professions.  Success  in  such  co- 
operation is  certain  to  enhance  the  attrac- 
tiveness of  North  Carolina  resources  for 
capital  investors.  Our  goal  is  growth. 
Healthy  and  happy  workers,  sound  in  body 
and  in  mind,  are  as  vital  as  dollars  in  mak- 
ing the  wheels  of  production  go  round  and 
in  making  them  grow. 


Economic  Influences  of  an  Industrial  Medical  Program 
On  a  County  Medical  Society 


Mac  Roy  Gasque,  M.D. 

and 

Carl  S.  Plumb,  MD. 

Pisgah  Forest 


It  is  a  well  known  and  accepted  fact  that  a 
thoughtfully  conceived  and  skillfully  ren- 
dered industrial  medical  program  can  have  a 
favorable  economic  impact  on  such  matters 
as  labor  turn-over,  absenteeism,  and  work- 
men's compensation  insurance  premium 
rates'1-1.  It  is  less  well  known  but  equally 
true  that  such  a  program  can  also  have  an 
important  economic  effect  on  the  private 
practice  of  medicine.  In  an  effort  to  cast 
light  on  the  matter,  this  essay  will  offer  a 
review  of  a  10-year  experience  of  physician 
participation  in  a  company-sponsored  Blue 
Cross  insurance  program  of  a  relatively 
large  industry. 

Approximately  11  years  ago,  this  industry 
employed  its  first  full-time  medical  director. 
A  few  months  later,  equipment,  space  and 
medical  staff  personnel  were  acquired. 
Thereafter  a  modern  industrial  medical  pro- 
gram was  gradually  put  into  effect. 
Early  Effects 

During  the  first  several  months  rumblings 
of  a  suspicious  discontent  arose  from  the 
county  medical  society.  Questions  of  this  sort 
were  asked :  "What  are  you  going  to  do  with 
all  that  space  and  equipment?"  "Are  you  go- 
ing to  treat  workers  for  their  personal  ill- 
nesses?" "Are  you  going  to  take  care  of  em- 
ployees' families?"   In   a   climate  of  mutual 


*Medical    Director,    Olin    Mathie^on    Chemical    Corporation,     Pif 
gah    Forest,  N.   C. 


good  will,  the  members  of  the  county  medical 
society  slowly  began  to  realize  that  the  pri- 
mary preventive  orientation  of  the  industrial 
medical  program  was  a  viable  reality  and 
not  just  a  high-sounding  statement  of  policy 
gibberish. 

Figure  1  shows  the  number  of  claims  filed 
against  the  company's  Blue  Cross  insurance 
plan  by  physicians  in  the  community.  Dur- 
ing the  early  years  of  the  study  only  three 
members  of  the  county  medical  society  were 
active  in  private  practice.  These  physicians 
are  designated  as  Doctors  A,  B  and  C.  It 
can  be  noted  that  during  the  first  three  years 
of  this  study  the  claims  filed  by  each  of  these 
physicians  more  than  doubled.  It  is  thought 
that  a  large  part  of  this  increase  in  medical 
activity  was  a  direct  result  of  the  industrial 
medical  program  which,  through  the  medium 
of  employee  meetings,  medical  films,  and  so 
forth,  emphasized  the  importance  of  health 
and  publicized  the  benefit  program.  Because 
of  the  growing  medical  opportunities,  begin- 
ning in  1953  three  additional  physicians  mi- 
grated into  the  community.  They  are  repre- 
sented in  figure  1  as  Doctors  D,  E  and  F. 

The  total  number  of  claims  per  year  is 
shown  in  figure  2.  It  is  significant  that  in 
1952  the  number  of  claims  more  than 
doubled.  It  was  in  this  year  that  the  services 
of  a  second  full-time  industrial  physician 
were  acquired.  A  program  of  periodic  physi- 


362 


NORTH    CAROLINA    MEDICAL   JOURNAL 


September,   1960 


INDIVIDUAL  PHYSICIAN  PARTICIPATION 
TEARS  {50—-  59) 


P* 


m 


r * 


aad 


S3    54    55    54    ! 
Dr.  A 


5)     54  55     Si    5'  58     59 
Or.  B 


53     53     54     55   56    37   5B     5?         S3     54     33   5*     37 

Dr.  C  Dr.  D 


»         53    34     53     54     57     ||     5* 

:>.  i 


Figure  1 


cal  examinations  for  all  employees  was  be- 
gun, and  a  backlog  of  abnormalities  was  un- 
covered. As  a  result,  literally  hundreds  of 
employees  were  referred  to  their  personal 
physicians  for  additional  diagnostic  study 
and  care. 

Although  the  number  of  employees  re- 
mained essentially  constant,  in  1956  an- 
other sharp  rise  in  claims  occurred.  In  this 
year  two  new  services  were  added  to  the 
industrial  medical  program:  (1)  an  annual 
gynocologic  survey131;  (2)  a  proctologic 
survey  of  all  men  over  40.  These  case-find- 
ing programs  resulted  in  many  additional 
referrals. 

These  facts  and  figures  give  definition  to 
one  type  of  medical  activity  which  has  had 
a  precise  and  significant  impact  on  the 
economy  of  a  county  medical  society.  More 
important  is  the  implication  that  these  fig- 
ures provide  a  faithful  index  of  a  general 
increase  in  community  medical  affairs,  re- 
sulting primarily  from  the  impetus  pro- 
vided by  an  active  industrial  medical  pro- 
gram. 

Description   of  Program 
It  is  a  fact  that  many  physicians  in  pri- 


vate practice  regard  industrial  medicine  as 
a  somewhat  vague,  third-party  device  which 
may  potentially  interfere  with  their  private 
practice.  In  an  effort  to  dispel  the  wariness 
that  many  feel  with  regard  to  the  unknown, 
there  follows  a  description  of  the  medical 
program  of  the  industry  referred  to  in  this 
study.  With  certain  modifications,  this  pro- 
gram is  typical  of  industrial  medical  prac- 
tice nationwide. 

A.  Physical  examinations 

1.  Pre-placement  physical  examinations: 
The  pre-placement  physical  examination  is 
becoming  standard  in  American  industry.  It 
is  a  multi-purpose  procedure,  the  primary 
importance  of  which  is  to  allow  employers 
to  bring  into  their  organizations  workers 
with  known  physical  assets.  In  addition,  it 
facilitates  the  skillful  placement  of  workers 
with  physical  limitations.  Rejection  occa- 
sionally is  necessary. 

In  order  for  a  physician  to  participate  ef- 
fectively in  the  placement  of  workers,  it  is 
mandatory  that  he  have  an  intimate  knowl- 
edge of  working  conditions  within  the  plant. 
He  must  know  the  demands,  both  physical, 


September,  1960 


INDUSTRIAL  MEDICAL  PROGRAM— GASQUE  AND   PLUMB 


363 


Figure  2 

emotional  and  intellectual,  of  the  various 
jobs,  and  he  should  attempt  to  calibrate  the 
assets  of  the  candidate  for  employment  with 
the  demands  of  the  job. 

A  pre-placement  physical  examination  can 
provide  an  important  base-line  of  employee 
health  against  which  later  examinations  can 
be  appraised  more  skillfully. 

2.  Periodic  physical  examinations:  Mod- 
ern medical  thinking  is  increasingly  support- 
ing the  principle  of  periodic  physical  exami- 
nations for  all  persons  who  have  more  than 
a  casual  interest  in  their  health.  Industry 
is  taking  the  lead  in  this  movement.  This 
development  has  come  about  partly  because 
of  the  obvious  good  sense  of  preserving  man- 
power. Trained  manpower  represents  indus- 
try's most  valuable  and  hard-to-replace  asset. 
In  terms  of  machinery  and  equipment,  it  is  a 
fact  that  good  maintenance  can  prevent  early 
obsolescence  and,  in  some  cases,  can  even 
prevent  operational  failure.  The  same  idea 
is  equally  true  when  applied  to  an  industrial 
worker.  Industry  has  found  that  it  is  not 
necessary  to  stand  idly  by  and  absorb  the 
losses  of  premature  failure  of  manpower'41. 
Speaking  broadly,  health  is  not  a  matter  of 
chance.  In  fact,  a  certain  and  important  de- 
gree of  health  is  purchasable.  Thoughtful 
management  supports  this  principle.  The 
wisdom  of  the  early  detection  of  disease  is 


apparent  to  all  medically  oriented  persons. 
These  ideas  underlie  industry's  interest  in 
periodic  physical  examinations. 

The  techniques  of  an  examination  done  in 
industry  are  different  from  those  used  in 
private  practice.  As  a  group,  industrial 
workers  come  to  industrial  doctors  as  well 
patients.  Their  complaints  are  few.  This 
puts  the  onus  of  responsibility  for  finding 
abnormalities  squarely  in  the  doctor's  hands. 
He  needs  to  be  a  scientifically  oriented  as 
well  as  an  intuitive  diagnostician.  The  mean- 
ing of  subtle  changes  in  physiology  must  be 
understood  by  the  physician  examining 
asymptomatic  patients. 

3.  Special  examinations  for  workers  ex- 
posed to  increased  hazards:  In  most  indus- 
tries there  are  work  areas  of  increased  haz- 
ard, involving  such  matters  as  dust,  noise, 
chemical  atmospheric  pollution,  and  chronic 
and  recurrent  psychologic  stress.  Workers 
exposed  to  hazards  of  this  sort  should  have 
pertinent  physical  examinations  at  appro- 
priate intervals. 

4.  Back-to-ivork  examinations  after  ill- 
ness: Workers  returning  to  their  jobs  after 
having  suffered  a  significant  injury  or  ill- 
ness should  be  appraised  regarding  their 
ability  to  return  to  their  usual  duties.  Some- 
times— for  example,  after  disabling  injuries 
involving  the  bones  and  joints — it  is  neces- 
sary for  employees  to  make  permanent 
changes  in  their  type  of  work.  Occasionally, 
after  suffering  an  infectious  disease,  an  em- 
ployee will  return  too  soon  and  while  he  is 
still  a  source  of  contagion.  Obvious  medical 
precautions  should  be  enforced. 

B.   Therapeutic  services  for 

1.  Industrially  induced  illnesses  and  acci- 
dents: A  nationwide  pattern  which  provides 
definitive  therapy  for  occupational  injuries 
or  diseases  is  being  established.  In  most 
states,  workmen's  compensation  legislation 
defines  the  responsibilities  of  employers 
and  the  limits  of  monetary  claims  by  em- 
ployees. 

2.  Personal  illnesses  and  accidents:  The 
appropriate  extent  of  therapy  for  personal 
illnesses  is  a  little  more  difficult  to  define.  It 
is  usual  to  provide  medical  care  which  will 
enable  an  employee  to  complete  his  shift  or 
will  provide  relief  of  pain,  and  to  treat  minor 
conditions  which  would  not  take  the  em- 
ployee to  his  personal  physician.  When  ther- 
apy goes  beyond  this  point,  it  probablv  is  not 
profitable  to  the  industry,  and  it  usually  will 


364 


NORTH   CAROLINA    MEDICAL  JOURNAL 


September,   1960 


bring  the  industrial  physician  into  sharp  is- 
sue with  local  medical  practitioners' ■'".  Com- 
petition with  or  replacement  of  conventional 
medical  agencies  should  be  scrupulously 
avoided.  The  industrial  physician  can,  how- 
ever, render  valuable  service  by  providing 
counsel  and  guidance  concerning  sources  of 
specialized  medical  care  for  personal  ill- 
nesses. 

The  part-time  industrial  physician  has  a 
particularly  delicate  problem  in  connection 
with  the  treatment  of  personal  illnesses.  He 
must  be  continuously  vigilant  in  order  to 
avoid  using  his  industrial  relationship  to 
build  up  a  private  practice.  The  principle  of 
free  choice  of  physician  must  always  be  kept 
in  mind.  Except  where  there  is  a  valid  per- 
sonal physician  relationship  with  an  indus- 
trial worker,  referrals  should  be  to  the  office 
of  the  worker's  private  physician  and  not  to 
the  office  of  the  part-time  industrial  physi- 
cian. Obviously,  in  some  situations  this  may 
be  difficult,  especially  in  very  small  commu- 
nities where  the  part-time  industrial  physi- 
cian is  one  of  a  small  number  of  physicians 
residing  in  the  locality. 

C.  Health   education 

Health  education  can  take  many  forms, 
and  it  certainly  should  include  the  more 
usual,  such  as  distribution  of  printed  ma- 
terial, bulletin  board  posters,  group  lectures, 
and  the  like.  Perhaps  the  most  important 
way  of  educating  an  industrial  population 
involves  the  long  and  sometimes  tedious  indi- 
vidual doctor-patient  contact,  as,  for  exam- 
ple, that  which  takes  place  at  the  periodic 
physical  examination.  These  examinations 
should  be  carried  out  in  a  climate  of  warmth 
and  friendliness,  and  they  contribute  to  pro- 
gressive rapport.  The  ready  availability  of 
a  physician  who  is  willing  and  able  to  inter- 
pret medical  questions  asked  by  employees 
provides  additional  opportunity  for  health 
education. 

D.  Industrial  hygiene 

The  safety  of  the  working  environment  is 
the  concern  of  the  industrial  hygienist.  He 
monitors  the  work  areas  to  determine  the 
degree  and  hazard  of  exposure  to  chemicals, 
radiation,  dust,  and  so  forth.  Activities  re- 
lated to  industrial  hygiene  are  usually  coor- 
dinated as  a  part  of  the  services  of  the  indus- 
trial medical  department. 

E.  Medical  records 

An  important  part  of  any  medical  program 
involves  good  record-keeping,  the  principal 
reasons  being:  (1)  They  enable  the  progress 


to  be  followed  of  any  sick  or  injured  em- 
ployee; (2)  they  provide  a  basis  for  adjudi- 
cation in  cases  of  compensable  injuries;  (3) 
they  enable  an  objective  industrial  physician 
to  appraise  the  activities  of  his  department 
and,  when  indicated,  to  modify  his  program. 
F.  Special  activities 

Depending  on  the  intellectual  and  person- 
ality turn  of  the  physician  and  the  industrial 
management  which  he  represents,  special  ac- 
tivities can  be  conceived  and  carried  out. 
Typical  services  provided  in  this  broad  cate- 
gory are : 

1.  Preventive  immunizations'01. 

2.  The  follow-up  of  workers  with  known 
or  suspected  chronic  diseases,  such  as  hyper- 
tension, obesity  or  diabetes. 

3.  Clinical  psychology  services'7'.  Indus- 
trial problems  involving  engineering,  produc- 
tion, finances  or  sales  are  often  readily  amen- 
able to  resolution.  There  is  no  such  ready 
resolution  of  problems  involving  the  ap- 
parently increasing  number  of  psychologi- 
cally maladjusted  and  disturbed  persons. 
The  industrial  psychologist  is  gaining  status 
and  increasingly  is  taking  his  place  as  an 
important  member  of  the  industrial  medical 
team. 

4.  Foot  care181.  Problems  involving  pain- 
ful feet  are  more  frequent  than  is  generally 
recognized.  While  not  usually  totally  disa- 
bling, they  can  be  distracting.  A  skillful 
podiatrist  can  offer  an  industry  a  service 
which  consistently  receives  a  warm  recep- 
tion. 

•5.  Proctologic  and  Gynecologic  Surveys'3'. 
As  a  rule,  assembly  line  techniques  should 
be  avoided  in  industrial  practice.  However, 
in  certain  types  of  survey  activities,  results 
justify  the  means.  Part-time  or  visiting  con- 
sultants can  frequently  be  integrated  into 
such  surveys. 

6.  Diabetic  detection.  This  service  should 
be  continuous,  and  workers  who  visit  the 
medical  department  should  be  encouraged  to 
leave  a  specimen  of  urine  in  the  clinical  lab- 
oratory. This  affords  the  opportunity  to  de- 
tect and  put  under  treatment  the  new  dia- 
betic patient  in  the  interval  between  peri- 
odic physical  examinations. 

Conclusion 
A  program  of  the  sort  described  in  this 
paper  can  be  expected  to  have  a  very  fa- 
vorable economic  influence  on  the  private 
practice  of  medicine  in  an  industrial  com- 
munity. 


September,  1960 


INDUSTRIAL  MEDICAL  PROGRAM— GASQUE  AND  PLUMB 


365 


Traditionally  the  medical  profession  has 
been  concerned  with  sickness  and  disease. 
The  ground  rules  of  industrial  medicine  al- 
low —  even  require  —  that  doctors  concern 
themselves  with  health — the  natural  history 
of  health  as  an  entity191.  Industrial  medicine 
is  changing  the  custom  of  waiting  for  ana- 
tomic and  physiologic  default.  Intervention 
in  the  interest  of  health  promotion  is  a  new 
pattern,  and  it  can  now  be  accomplished  by 
the  application  of  documented  techniques  of 
health  education  and  of  early  detection  and 
prevention  of  disease. 

References 

1.     Casque.      M.      R.:      Occupational      Health      Pays      Dividends. 
North    Carolina    M.    J.    18:154-157     (April)     1957. 


Hubbard.    J.    P.:     The    Early    Detection    and    Prevention    of 
Disease.    New    York.    The    Blakiston    Press,    1957. 
Casque.     M.     R.,    Plumb,    C.     S..    and    DeBord,     M.A.:     The 
"How"    of   an    Industrial    Gynecologic    Survey,    J.    Occupa- 
tional   Med.    2:214     (May)     1960. 

Seymour.  W.  H.:  What  Industry  Needs  from  the  Med- 
ical Profession,  American  Congress  of  Occupational  Medi- 
cine,   Mexico    City,    February,    1958. 

Wade,  L.  J.:  Needed:  A  Closer  Look  at  Industrial  Med- 
ical Programs,  Harvard  Business  Review  34:81  March- 
April,    1956. 

Committee  on  Industrial  Health  Emergencies  of  the 
Council  on  Industrial  Health:  Guide  for  Industrial  Im- 
munization Programs,  J.A.M.A.  171:2097  (Dec.  12),  1959. 
Sorkey,  H.:  Trends  in  Industrial  Psychology.  South.  M.J. 
52:1128-1131     (Sept.)     1959. 

Casque,  M.R.,  and  Holt,  G.F. :  An  Experiment  in  In- 
dustrial Foot  Health.  South.  M.J.  46:275-278  (March),  1953. 
Gasque,  M.  R. :  Trends  and  Direction  in  Occupational 
Medicine,    South.    M.J.    62:309-313     (March)     1959. 


Compensable  Occupational  Diseases  Under  the 
North  Carolina  Workmen's  Compensation  Act 


J.  W.  Bean* 
Raleigh 


The  North  Carolina  Industrial  Commis- 
sion is  an  administrative  agency  of  the  state 
which  is  charged  with  the  responsibility  of 
administering  the  North  Carolina  Work- 
men's Compensation  Act.  The  Commission 
was  created  in  1929  by  the  State  Legislature, 
and  its  duties,  power,  and  authorities  come 
from  statute  law,  as  enacted  by  the  Legis- 
lature and  as  interpreted  by  the  Supreme 
Court. 

The  economic  theory  underlying  work- 
men's compensation  is  referred  to  frequently 
as  the  doctrine  of  occupational  risk. 

The  history  of  workmen's  compensation 
legislation  shows  that  the  state  legislators 
intended  to  enact  compensation  laws  to  cover 
these  fundamental  points : 

1.  Provide  to  victims  of  work  accidents 
and  occupational  diseases  and  their  depen- 
dents certain  prompt  and  reasonable  compen- 
sation, plus  medical  treatment  for  the  worker 
for  injuries  which  arose  out  of  and  in  the 
course  of  his  employment. 

2.  Free  the  courts  from  delays,  costs,  and 
tremendous  work-load  of  this  mass  of  per- 
sonal injury  litigation. 

3.  Relieve  public  and  private  charities  of 
the  fundamental  drain  caused  by  uncompen- 
sated industrial  accidents. 


^Chairman,     North     Carolina     Industrial    Commission.     Raleigh. 


Designation  of  Occupational  Diseases 

Under  the  provisions  of  North  Carolina 
Workmen's  Compensation  Act,  certain  dis- 
eases are  designated  as  being  occupational 
diseases.  The  Act  enumerates  27  causes  or 
conditions  which  result  in  compensable  occu- 
pational diseases,  and  defines  the  Commis- 
sion's responsibility  for  occupational  health 
in  terms  of  such  diseases. 

The  following  diseases  and  conditions  have 
been  classified  as  occupational  diseases  with- 
in the  meaning  of  the  Act : 

1.  Anthrax 

2.  Arsenic  poisoning 

3.  Brass  poisoning 

4.  Zinc  poisoning; 

5.  Manganese  poisoning 

6.  Lead  poisoning 

7.  Mercury  poisoning 

8.  Phosphorus  poisoning 

9.  Poisoning  by  carbon  bisulphide,  methanol, 
naphtha   or  volatile   halogenated   hydrocarbons 

10.  Chrome  ulceration 

11.  Compressed-air  illness 

12.  Poisoning  by  benzol,  or  by  nitro  and  amido 
derivatives  of  benzol  (dinitrol-benzol,  anilin,  and 
others) 

13.  Infection  or  inflammation  of  the  skin  or  eyes 
or  other  external  contact  surfaces  or  oral  or  nasal 
cavities  due  to  irritating  oils,  cutting  compounds, 
chemical  dust,  liquids,  fumes,  gases  or  vapors,  and 
any  other  materials   or  substances 


366 


NORTH   CAROLINA    MEDICAL  JOURNAL 


September,   1960 


Table  1 

Summary  of  Occupational   Diseases   Handled   by 

The  North   Carolina   Industrial   Commission 

July   1,   1958,  through   June  30,   1959 


Causes  and   Diseases 


Total  No. 
of  Cases 


Total 
Compensation 


Total 
Medical  Cost 


Total 

Days   Lop 


Anthrax    1 

Arsenic  16 

Asbestosis    _. _. 1 

Blisters _... 8 

Bone  felon  5 

Bursitis  of  elbow.. _  5 

Bursitis  over  patella 2 

Brucellosis   I 

Carbon  bisulphide  3 

Carbon   dioxide   1 

Carbon  monoxide  16 

Caustics .... 

Cellulitis 7 

Chlorine    _.. 1 

Formaldehyde   6 

Infection  or  inflammation  to  skin  or 

eyes  due  to  specific  substances ._. 258 

Lead  poisoning 9 

Myopia 

Nitrobenzol    

Occupational  neurosis  .... 

Petroleum  distillates  1 

Silicosis  (16)* 21 

Synovitis    28 

Wood  poisoning 1 

Zinc   poisoning 1 

All  other  poisoning 13 


10 

6,000 

456 

27 

45 

"  175 

680 

185 
"38 


210 
393 

"263 
216 
334 

81 

396 

349 

5 

1,056 


12,187 
552 


209 

89 

186 

21,387 
851 


23 

104 
17 
23 
5 
35 
36 

101 

19 


2,592 
170 


120,169 
1,216 


1,120 


20 

1,976 

1,099 

2 

63 

829 


2,231 
375 


:58 


Overall    totals    (16) 


405 


$142,860 


$30,014 


5,998 


14.  Epitheliomatous  cancer  or  ulceration  of  the 
skin  or  of  the  corneal  surface  of  the  eye  due  to  tar, 
pitch,  bitumen,  mineral  oil,  or  paraffin,  or  any  com- 
pound, product  or  residue  of  any  of  these  substances 

15.  Radium  poisoning  or  injury  by  x-rays 

16.  Blisters  due  to  use  of  tools  or  appliances  in 
the  employment 

17.  Bursitis  due  to  intermittent  pressure  in  the 
employment 

18.  Miner's  nystagmus 

19.  Bone  felon  due  to  constant  or  intermittent  pres- 
sure in  employment 

20.  Synovitis,  caused  by  trauma  in  employment 

21.  Tenosynovitis,  caused  by  trauma  in  employ- 
ment 

22.  Carbon  monoxide  poisoning 

23.  Poisoning  by  sulphuric,  hydrochloric  or  hydro- 
fluoric acid 

24.  Asbestosis 

25.  Silicosis 

26.  Psittacosis 

27.  Undulant  fever 

Diseases  caused  by  the  use  of  chemicals 
shall  be  termed  occupational  diseases  only 
when  the  employee  has  been  exposed  to  the 
chemicals  mentioned  above,  in  his  employ- 
ment, in  such  quantities,  and  with  such  fre- 
quency as  to  cause  the  compensable  disease. 

Coverage 

Claims  may  be  made  only  for  diseases  re- 
sulting from  these  enumerated  causes  or 
conditions.    Complete  coverage  of  all  occu- 


pational diseases  has  been  the  trend  in  work- 
men's compensation  laws  during  recent 
years.  Eighteen  states,  including  North 
Carolina,  however,  cover  only  certain  enum- 
erated diseases.  Three  states  have  no  pro- 
vision whatever  in  their  laws  for  coverage 
of  occupational  diseases,  but  full  coverage 
can  be  provided  for  under  workmen's  com- 
pensation law  by  various  methods.  One  is 
by  simple  definition  of  the  term  "injury," 
which  in  various  states  has  various  mean- 
ings ;  in  some  states  it  includes  occupational 
diseases.  In  other  states  full  coverage  has 
been  obtained  by  amending  the  law  and  add- 
ing other  diseases  to  the  schedule  listing  of 
diseases. 

A  person  disabled  by  occupational  disease, 
if  it  arises  out  of  and  in  the  course  of  his 
employment,  should  be  as  much  entitled  to 
workmen's  compensation  benefits  as  a  per- 
son disabled  by  an  accidental  work  injury. 
In  either  case  the  worker  is  actually  injured, 
whether  it  be  from  disease  or  accident,  and 
in  either  case  the  disability  has  arisen  out 
of  the  worker's  employment  or  the  environ- 
mental condition  of  his  employment. 

Claims  Filed  in  North  Carolina 
for  1958-1959 
The  following  table  presents  a  recapitula- 
tion of  claims  for  occupational  diseases  filed 


September,   1960 


WORKMEN'S  COMPENSATION— BEAN 


367 


with  the  Commission  during  the  fiscal  year 
1958-1959. 

Silicosis  and  asbestosis  constitute  the  ma- 
jor cost  of  occupational  disease  adjudicated 
under  the  North  Carolina  Workmen's  Com- 
pensation Law.  However,  the  incidence  of 
these  diseases  is  gradually  being  reduced  in 
North  Carolina  as  various  safety  methods 
are  brought  into  play  and  as  more  interest 
is  shown  by  employers  and  employees  in 
eliminating  dust  hazards. 

The  expanding  use  of  atomic  energy  for 
industrial  purposes  is  resulting  in  the  ex- 
posure  of  more   and   more   workers   to   the 


hazard  of  ionizing  radiation.  Provision  of 
workmen's  compensation  protection  for  all 
gainfully  employed  workers  who  may  be  ex- 
posed to  ionization  radiation  is  a  problem 
which  needs  serious  study,  as  well  as  the  use 
of  certain  new  chemicals  in  industry.  At  the 
present  time  no  one  seems  to  know  just  what 
would  be  the  best  course  to  pursue  in  this 
respect. 

The  use  of  new  chemicals  and  atomic  en- 
ergy is  presenting  a  new  challenge  in  the 
field  of  occupational  diseases,  and  it  will  take 
the  full  cooperation  of  the  medical  profes- 
sion, the  employer,  the  employee,  and  the 
general  public  to  solve  this  problem. 


Radiation  Hazards  in  Industry 


Thomas  S.  Ely,  M.D. 
Washington,  D.  C. 


Recognition  of  the  harmful  effects  of  ion- 
izing radiation  occurred  shortly  after  the 
discovery  of  x-ray  and  radium  in  1895.  The 
acute  effects  of  high  doses  of  x-ray  were  seen 
in  1896  and  the  carcinogenic  effect  in  1902. 
Although  cases  of  radiation  injury  have  con- 
tinued to  spot  the  record  since  that  time,  the 
potential  sources  were  comparatively  small 
until  the  beginning,  in  1942,  of  what  has 
been  called  the  "Nuclear  Age."  In  the  early 
forties  the  vast  growth  of  the  nuclear  in- 
dustry with  the  Manhattan  Engineering  Dis- 
trict, subsequently  to  become  the  Atomic 
Energy  Commission,  involved  extremely 
large  operations — a  very  rapid  expansion — 
conducted  under  Federal  Government  control 
with  a  very  high  degree  of  secrecy.  These 
factors  contributed  to  the  result  that  the  nu- 
clear industry  grew  up  with  an  exceptionally 
good  record  of  radiation  health  control  in 
contrast  to  most  of  the  other  industrial 
hazards,  which  have  been  controlled  only 
after  a  certain  amount  of  human  injury  was 
experienced.  Another  result  of  the  unique 
beginning  has  been  a  certain  aura  of  mystery 
surrounding  radiation,  radiation  hazards, 
and  radiation  effects,  which  persists  to  a 
large  extent  to  the  present. 

The  current  operations  of  the  Atomic  En- 
ergy Commission  are  carried  out  mainly  un- 
der contracts,  and  involve  more  than  100,000 
employees.    Most  of  them  work  in  large  in- 


•Assistant  Chief,  Health  Protection  Branch.  Office  of  Health 
and  Safety,  U.  S.  Atomic  Energy  Commission.  Washington 
25,    D.    C. 


dustries,   each   of  which  has  a   well   staffed 
health  and  safety  department. 

The  Atomic  Energy  Act  of  1954  provided 
for  a  program  of  radioisotope  licenses,  which 
has  greatly  expanded  the  amount  of  radioac- 
tive material  that  is  available  to  private  in- 
dustries and  individuals  not  under  the  com- 
prehensive surveillance  of  the  Atomic  En- 
ergy Commission.  The  result  has  been  that 
smaller  installations,  much  smaller  in  many 
cases,  have  come  into  the  radiation  business. 
A  more  competitive  situation  often  exists 
under  these  conditions,  and  the  result  is 
sometimes  felt  by  the  health  protection  staffs 
involved.  The  smaller  organizations  having 
licenses  necessarily  have  smaller  health 
staffs,  usually  with  less  training  in  the  spe- 
cial field  of  radiation  health.  More  and  more 
general  practitioners,  internists,  and  sur- 
geons have  become  involved  in  providing 
these  services,  often  on  a  part-time  basis.  It 
is  therefore  apparent  that  there  is  a  need 
for  greater  understanding  and  education  in 
the  medical  field  regarding  radiation  haz- 
ards and  the  treatment  of  radiation  injury. 

Effects  of  Radiation 
No  medical  effect  of  radiation  is  unique 
from  an  etiologic  standpoint.  Some  effects, 
however,  are  not  often  associated  with  other 
causes.  Some  of  the  better  known  harmful 
effects  of  radiation  follow. 

High   dosage 

The  acute  radiation  syndrome  which  fol- 
lows a  short  exposure  to  a  high  dose  of  ex- 


368 


NORTH   CAROLINA    MEDICAL  JOURNAL 


September,   19(50 


ternal  penetrating  radiation  of  several  hun- 
dred or  more  roentgens  is  well  documented 
and  offers  little  diagnostic  difficulty,  partic- 
ularly when  there  is  a  good  history  of  dosage. 
The  condition  has  been  seen  in  patients  re- 
ceiving radiation  therapy,  in  the  Japanese 
and  Marshallese  radiation  experience,  and 
in  an  occasional  industrial  accident. 

Acute  erythema  and  chronic  trophic  ef- 
fects on  the  skin  following  doses  of  the  order 
of  thousands  of  roentgens  have  been  known 
since  shortly  following  the  discovery  of  the 
x-ray. 

Some  carcinogenic  effects  of  radiation 
have  been  well  documented.  There  were  the 
leukemias  of  the  early  radiologists  and  of 
the  Japanese ;  the  bone  sarcomas  of  the  ra- 
dium dial  painters  and  of  the  patients  given 
radium  therapeutically  during  the  thirties; 
the  skin  cancers  of  the  early  x-ray  workers ; 
the  liver  sarcomas  of  patients  who  were 
given  thorium  dioxide  as  a  contrast  medium, 
and  the  bronchogenic  cancer  in  miners, 
which  occurred  as  early  as  the  middle  nine- 
teenth century  but  was  not  attributed  to 
radon  and  its  daughters  until  1942. 

Cataracts  have  been  seen  occasionally,  par- 
ticularly in  workers  with  the  earlier  cyclo- 
tron and  other  high  energy  accelerators  who 
received  high  doses  to  their  lenses.  Tempo- 
rary sterility  has  occurred  in  cases  of  high, 
acute  radiation  doses.  In  all  the  above  cases 
the  doses  have  been  very  high,  in  the  order 
of  hundreds  or  thousands  of  roentgens. 

Genetic  mutations  have  been  shown  to  oc- 
cur in  fruit  flies  and  in  mice,  and  it  is  prob- 
able that  a  similar  effect  would  occur  in  a 
human  population,  although  it  is  not  likely 
to  be  measurable  in  any  practical  human  sit- 
uation because  of  statistical  limitations.  With 
regard  to  the  genetic  effect,  it  is  the  total 
dose  of  radiation  to  an  inbreeding  popula- 
tion rather  than  the  dose  to  any  segment  or 
individual  that  is  significant. 

In  laboratory  animals  it  has  been  demon- 
strated statistically  that  high  doses  of  radi- 
ation have  nonspecific  life-shortening  effects, 
but  the  evidence  in  studies  on  human  beings 
is  not  conclusive. 

Low  dosage 

All  the  above  effects  have  resulted  from 
relatively  large  doses  of  radiation.  No  con- 
clusive demonstration  of  injury  from  low 
doses  of  ionizing  radiation  in  human  beings 
has  been  made  as  yet.  Our  estimation  of 
the  effects  of  low  closes,  therefore,  must  be 
based  on  the  effects  of  high  doses.   Since  the 


information  available  is  not  sufficient  to  per- 
mit the  demonstration  of  the  threshold  that 
exists  for  most  other  noxious  agents,  in  gen- 
eral the  effects  of  low  doses  have  been  esti- 
mated on  the  basis  of  a  linear  interpolation 
from  the  effects  of  high  doses,  which  yields 
probably  the  most  pessimistic  interpretation. 

Standards 

Several  groups  have  developed  standards 
of  radiation  exposure  that  are  currently  in 
use  in  this  country.  In  1929  an  organization 
which  subsequently  became  known  as  the 
National  Committee  on  Radiation  Protection 
and  Measurements  (NCRP),  began  develop- 
ing standards  of  exposure  based  on  the  haz- 
ards of  x-ray  and  radium,  which  were  the 
main  sources  of  radiation  in  those  early  days. 
The  committee  is  an  independent  group.  It 
has  been  expanded  and  diversified  in  the  in- 
tervening years  to  meet  industrial  needs,  and 
has  published  several  handbooks  which  have 
proved  useful  in  the  field  of  radiation  pro- 
tection. Currently  the  most  widely  used  are 
Handbook  59,  which  presents  standards  of 
exposure  to  external  radiation"1,  and  Hand- 
book 69,  which  lists  standards  of  concentra- 
tion in  air  and  water  for  some  240  radioiso- 
topes'2'. 

The  American  Standards  Association 
(ASA)  has  developed  and  is  developing  ra- 
diation standards  and  codes  covering  several 
different  phases  of  the  nuclear  industry. 

In  1959  the  President  and  the  Congress  es- 
tablished the  Federal  Radiation  Council 
(FRC),  which  is  a  cabinet-level  organization 
with  responsibility  to  "  .  .  .  advise  the  Presi- 
dent with  respect  to  radiation  matters,  di- 
rectly or  indirectly  affecting  health,  includ- 
ing guidance  for  all  federal  agencies  in  the 
formulation  of  radiation  standards  and  in 
the  establishment  and  execution  of  programs 
of  cooperation  with  States  ..."  Report  No. 
1  of  the  FRC  was  issued  on  May  13,  I960'3'. 

These  three  organizations  are  not  in  direct 
competition  with  each  other.  In  general,  the 
NCRP  has  developed  primary  and  secondary 
standards  of  exposure  on  a  broad  basis,  the 
ASA  has  written  detailed  codes  of  operation 
and  measurements,  and  the  FRC  has  pro- 
vided an  official  basis  for  the  government 
use  of  radiation  standards  and  coordinated 
application  of  standards  at  the  level  of  fed- 
eral agencies. 

In  general,  the  values  are  in  agreement. 
For  external  exposure  of  the  whole  body  to 
radiation,     the     occupational     value     is     3 


September,  1960 


RADIATION  HAZARDS  IN  INDUSTRY— ELY 


369 


Table  1 
External  Exposure  of  AEC  Radiation  Workers,  1958 


Dose  in  Rems 

0-  1 

1  -2 

2-3 

3-4 

4-5 

5-6 

6-7 

7-8 

8-9 

9-10 
10-11 
11-12 
12-13 
13-14 
14-15 
15  plus 


No.  of  Employees 

59,455 

4,041 

1,652 

407 

171 

67 

31 

27 

23 

11 

4 

1 

3 

2 

0 

12 


rems  per  quarter  and  an  average  of  5  rems 
per  year.  For  parts  of  the  body  or  individ- 
ual organs,  the  standard  of  exposure  is  gen- 
erally higher. 

Exposures 

The  actual  exposures  to  workers  in  radia- 
tion from  occupational  sources  can  be  seen 
in  table  1,  which  is  a  tabulation  of  the  re- 
corded external  radiation  doses  to  Atomic 
Energy  Commission  radiation  workers  for 
1958.  ' 

Although  this  tabulation  represents  only 
one  year's  record,  it  is  typical  of  the  ex- 
posures of  other  years.  It  is  apparent  that 
the  great  majority  of  the  doses  were  very 
low  compared  to  the  radiation  standards  in 
effect.  All  the  higher  doses  resulted  from 
accidental  exposures,  and  only  a  few  of  those 
were  above  the  standard  of  3  rems  per  quar- 
ter or  an  average  of  5  rems  per  year. 

In  table  2  are  listed  most  of  the  sources 
and  approximate  doses  of  radiation  to  which 


the  average  population  is  exposed  currently. 
The  values  were  derived  from  the  Federal 
Radiation  Council  Report  No.  1. 

Although  the  values  are  only  approximate, 
the  table  serves  to  show  that  the  dosage  to 
the  main  population  is  coming  from  essen- 
tially two  sources.  The  first  is  natural  radi- 
ation, which  has  existed  since  the  beginning 
of  mankind.  The  other  is  medical  x-ray, 
which  became  a  factor  at  the  turn  of  the  cen- 
tury. It  is  apparent  that  such  sources  as  in- 
dustrial radiation,  fallout,  luminous  dials, 
and  television  sets  comprise  only  a  negli- 
gible portion  of  the  total  dosage  to  which  the 
average  population  is  exposed. 

Prevention 

The  practice  of  occupational  health  in  ra- 
diation industry  is  almost  entirely  preven- 
tive, very  little  being  curative.  Certainly 
this  represents  the  desirable  trend  in  occu- 
pational health  in  general,  but  the  radiation 
case  seems  to  be  in  the  forefront  of  the  trend. 
There  have  been  a  total  of  three  accidental 
deaths  caused  by  the  Manhattan  Engineer- 
ing District  and  Atomic  Energy  Commission 
operations,  constituting  about  1  per  cent  of 
all  industrial  deaths.  Nonfatal  radiation  in- 
juries probably  constitute  a  similarly  small 
portion  of  the  total  injuries.  The  total  inci- 
dence of  injuries  due  to  radiation  and  con- 
ventional hazards  has  been  better  than  that 
of  most  other  industries. 

Thus  most  of  the  practice  of  the  industrial 
physician  in  a  radiation  industry  will  be  con- 
ventional occupational  medicine.  Employees 
will  continue  to  fall  down,  cut  themselves,  get 
burned,  and  become  chemically   intoxicated 


Table  2 

Approximate   Average  Annual  Soft   Tissue 

Radiation   Dose  to  the  Population 


Source 

Dose  in  Millirems 

Comment 

Natural 

External 

Cosmic  rays 

32-73 

Terrestrial  gamma  rays 

25-75 

Internal 

Potassium-40 

19 

Carbon-14 

1.6 

Radium-226 

2-15 

Questionable  values 

Man-made 

_, 

Medical   (exposure  to  patients) 

Diagnostic  x-rays 

50-100 

Therapy 

— 

Not  available 

Internal  radionuclides 

1-10 

Questionable  values 

Occupational 

20 

High  estimate 

Environs  of  medical  and  industrial 

5 

High  estimate 

sources 

Fallout 

2 

Other    (luminous   dials,  TV,  etc.) 

1-3 

370 


NORTH    CAROLINA    .MEDICAL   JOURNAL 


September,  1960 


in  almost  any  industrial  setting.  The  indus- 
trial physician's  main  responsibility  regard- 
ing the  radiation  hazard  is  to  assist  in  the 
prevention  of  injury  and  of  overexposure.  A 
comparatively  frequent  task  in  some  circum- 
stances may  be  the  decontamination  of  an 
employee — that  is,  the  removal  of  radioac- 
tive material  externally  or,  less  frequently, 
internally.  This  procedure  is  really  preven- 
tive in  nature  rather  than  curative,  in  that 
decontamination  prevents  the  delivery  of  a 
radiation  dose. 

Diagnosis 

The  physician  in  a  nuclear  industry  should 
be  prepared  for  and  expect  occasional  radia- 
tion injuries,  and  although  the  cases  on 
which  to  gain  experience  have  been  few  and 
far  between,  he  should  be  prepared  to  diag- 
nose and  treat  the  injury.  He  should  make 
a  clear  distinction  between  a  radiation  dose 
and  a  radiation  effect.  They  are  too  often 
equated.  The  determination  of  a  radiation 
dose  is  the  responsibility  of  an  industrial  hy- 
gienist  or  health  physicist;  the  diagnosis  of 
a  radiation  effect  is  a  medical  responsibility. 

Some  effects  are  characteristic  enough  and 
appear  promptly  enough  to  make  it  easy  to 
determine  the  cause.  After  a  long  latent  per- 
iod following  a  low  or  unknown  dose  of  radi- 
ation, however,  the  diagnosis,  may  have  to 
be  based  on  the  probabilities  of  the  situation, 
many  of  which  are  essentially  unknown  at 
the  present  time.  A  statement  on  the  diag- 
nosis and  compensation  of  radiation  injury 
by  the  Radiation  Committee  and  Compensa- 
tion Committee  of  the  Industrial  Medical  As- 
sociation may  be  of  interest  in  this  connec- 
tion141. 

Treatment 

There  is  no  specific  treatment  for  radia- 
tion injury.  This  is  not  to  say  that  there  is 
no  need  for  specific  competence  in  the  field, 
but  rather  that  many  of  the  familiar  tech- 
niques for  treating  more  conventional  injur- 
ies are  equally   important  in  the  treatment 


of  those  caused  by  radiation.  The  acute  radi- 
ation syndrome  due  to  exposure  of  the  whole 
body  is  treated  basically  by  the  usual  symp- 
tomatic and  supportive  measures.  In  very 
serious  cases,  bone-marrow  transfusions 
have  been  tried,  but  this  is  still  an  experi- 
mental procedure. 

The  treatment  of  radiation  burns  is  not 
basically  different  from  that  of  thermal 
burns,  and  the  techniques  of  the  general  and 
plastic  surgeon  will  be  most  useful  in  these 
cases.  Since  the  delayed  effects  of  radiation 
cannot  usually  be  differentiated  from  other 
conditions,  it  follows  that  the  treatment 
would  not  be  different. 

Summary 

With  the  expanding  uses  and  usefulness 
of  radiation  and  radioactive  materials  in  in- 
dustrial and  everyday  life,  there  will  be  in- 
creased need  for  the  services  of  occupational 
health  personnel.  Injury  from  radiation  is 
and  should  be  a  vanishing  component  of  in- 
jury from  all  causes,  and  the  practice  of  radi- 
ation health  should  be  limited  almost  exclu- 
sively to  prophylaxis.  Much  of  the  treatment 
of  radiation  injury  is  familiar  from  conven- 
tional medical  experience,  and  those  in  the 
medical  profession  can,  with  some  additional 
education  in  the  nature  of  radiation  and  radi- 
ation hazards,  contribute  considerably  to  the 
field  of  industrial  radiation  health. 

References 

1.  National  Bureau  of  Standards  Handbook  59.  September 
24.  1954  (extended  January  8.  1957).  For  sale  by  the 
Superintendent  of  Documents,  Washington  25,  D.  C. 
Price   35    cents. 

2.  National  Bureau  of  Standards  Handbook  69,  June  5,  1959. 
For  sale  by  the  Superintendent  of  Documents,  Washing- 
ton   25.    D.    C.    Price    35    cents. 

3.  Background  Material  for  the  Development  of  Radiation 
Protection  Standards,  Report  No.  1  of  the  Federal  Radia- 
tion Council,  May  13.  1960.  For  sale  by  the  Superintendent 
of    Documents.    Washington    25,    D.    C    Price    30    cents. 

4.  Statement  on  the  Diagnosis  and  Compensation  of  Harm- 
ful Effects  Arising  as  a  Result  of  Work  Involving  Ex- 
posure to  Ionizing  Radiation.  Statement  of  the  Radiation 
Committee  and  Compensation  Committee  of  the  Industrial 
Medical    Association.    J.    Occupational    Med.,    in     press. 


September,  1960 


371 


Physical  Requirements  in  Textile  Manufacturing 


Charles  G.  Gunn,  Jr.,  M.D.* 
Winston-Salem 


Textile  manufacturing  has  contributed 
more  to  the  economic  growth  of  our  state 
than  any  other  industry.  In  1958,  the  last 
year  for  which  we  have  figures,  one  fourth 
of  the  gross  wages  for  all  North  Carolina 
industry  (manufacturing  and  non-manu- 
facturing combined)  was  paid  to  textile 
workers.  Forty-three  per  cent  of  the  man- 
ufacturing payroll  was  paid  to  textile  em- 
ployees in  that  year,  and  the  chances  of 
guessing  the  occupation  of  a  Tar  Heel  in- 
dustrial worker  correctly  were  50-50  if  you 
said,  "He's  in  textiles."'1' 

So  universal  a  manufacturing  process 
affects  each  of  us  in  our  practice  of  medi- 
cine. We  care  for  the  health  of  textile 
workers  in  virtually  every  county  in  North 
Carolina  (fig.  1).  Of  the  24  counties  with- 
out textile  manufacturing,  all  but  4  are 
adjacent  to  counties  with  textile  plants. 
These  non-industrial  counties,  of  course, 
contribute  commuting  employees  to  the 
other  counties.  It's  a  sure  bet  that  96  per 
cent  of  the  members  of  our  State  Medical 
Society  have  treated  at  least  one  textile  em- 
ployee (or  his  or  her  family)  in  the  past 
week. 

Table  1  lists  the  types  of  textile  indus- 
tries operating  in  North  Carolina  in  1958, 
with  the  number  of  employees'-'. 


Table  1 
Types  of  Textile  Industries  in 

North   Carolina  in   1958 
Industry  No.  Employees 


1. 

Yarn  and   thread   mills 

45,800 

2. 

Knitting  mills 

63,765 

3. 

Narrow  woven  or  braided  fabrics 

1,859 

4. 

Broad   woven  cotton   fabrics 

68,477 

5. 

Broad  woven   cotton, 

man-made  fiber  and   silk 

23,087 

6. 

Broad  woven  wool  fabrics 

4,528 

7. 

Dyeing-  and   finishing   textiles 

7,276 

8. 

Apparel   and   other 

finished  products 

26,514 

9. 

Floor-covering   mills 

900 

0. 

Miscellaneous   textile   goods 

3,417 

Total 


245,623 


♦Medical      Director,      Hanes      Hosiery      Mills,      Winston-Sa'em, 
North    Carolina. 


It  is  the  purpose  of  this  paper  to  review 
one  or  two  typical  operations  in  each  type 
of  major  industry,  describing  by  picture 
and  exposition  the  physical  requirements 
for  an  employee  engaged  in  each  represent- 
ative job.  Where  textile  manufacturing 
operations  are  related  or  similar — for  ex- 
ample, nos.  3,  4,  5,  6  (table  1) — one  pic- 
ture and  description  will  be  used. 

From  Yarn  to  Fabric 
Whatever  the  end  product  may  be  (nos. 
2  through  10)  the  first  step  has  to  do  with 
the  yarn.  This  may  be  vegetable  or  animal 
fiber,  or  man-made  (synthetic).  In  figure 
2  a  speeder  tender  (or  roving-frame  ten- 
der) is  operating  a  machine  drawing  cotton 
sliver   into    roving,    which    will    be    reduced 


MONTHLY    AVERAGE     EMPLOYMENT    FOR    YEAR     1957 


£  C  Q  C  H  2 
I  20. 000-J5. 000  |:||||;,  000-4.999 

I  IOaVO  19.999     I  1  500  I  999 

!->:*:j  5.000-9.999     j   ^1.499 

None  -  Unshaded 


Fig.   1.  County  distribution   of  covered   employment    in   textiles.    (Courtesy,    Employment    Security   Com- 
mission of  North   Carolina.) 


::7L' 


PHYSICAL  FACTORS  IN   TEXTILE   INDUSTRIES— GUNN  September,  1960 


Fig.   2.   Speeder   tender   or  roving  frame  tender. 

This  speeder  tender  is  responsible  for  four  machines,  each  holding  120  bobbins  of  roving.  He  must 
constantly  inspect  for  broken  ends.  He  removes,  or  doffs,  the  completed  bobbin  and  replaces  it  with  an 
empty  one.  Proper  humidity  is  essential  for  an  efficient  operation.  Vision,  tactile  sensibility,  freedom  of 
motion  in  all  joints  (for  reaching  and  lifting),  and  manual  dexterity  are  considered  primary  in  his  work. 
Note  the  safe  manner  in  which  he  carries  his  pneumatic  roll-picker  over  his  shoulder  in  the  cleaning  op- 
eration. 


/y 

"DOFFING    THE 
TAKE -UP  PACKAGE. 


Fig.  3.   Fluflon   operator. 

This  young  lady  is  responsible  for  the  constant  observation  of  more  than  two  thousand  heat  cans  and 
their  pirns  and  take-up  packages.  She  must  watch  for  breaks  in  the  yarn.  She  is  walking  50  per  cent 
of  the  time.  This  work  requires  a  high  degree  of  visual  accuity,  exceptional  tactile  sense,  and  a  full  range 
of  motion  in  all  joints.  Again,  humidity  plays  an  important  part  in  the  quality  of  the  finished  product. 
Air  conditioning  offers  a  more  uniform  environment  and  product,  as  well  as  a  more  efficient  employee. 
Fluflon,   like   nylon   and   dacron   is   a   svnthetic   vara. 


September,  1960  PHYSICAL  FACTORS  IN   TEXTILE   INDUSTRIES— GUNN 


373 


G 


/  COMPLETED 
(    STOCKING 

(POLD  DOWN') 


<?    i 


Fig.  4.  Knitter. 

This  knitter  walks  along  an  aisle  of  30  machines.  He  is  responsible  for  removing  the  finished  knit 
cylinder  of  the  embryo  stocking  and  inspecting  it  on  a  board,  rolled  along  as  he  walks.  Note  the  folding 
step  to  permit  adjustments  and  threading  at  the  top  of  the  machine.  Full  shoulder  and  knee  motion 
is  a  prerequisite  for  this  operation,  as  is  excellent  manual  dexterity  and  a  mechanical  aptitude.  Note  the 
pans  under  the  machines  to  retain  oil   and   prevent  spread  to  the   aisle. 


even  more  in  diameter  by  a  similar  opera- 
tion before  knitting  (or  weaving)  takes 
place. 

The  chemical  or  thermal  treatment  of 
yarn  prior  to  use  gives  it  unusual  charac- 
teristics. In  figure  3  a  fluflon  operator  is 
taking  off  (doffing)  a  take-up  package  up- 
on its  completion.  The  yarn  has  coursed 
from  the  pirn  through  a  heat  can  while  un- 
der a  fixed  amount  of  twisting  and  tension 
to  give  it  recoil  or  springy  properties,  and 
upward  again  to  the  take-off  package. 

The  two  operations  that  put  the  yarn  or 
thread,  whether  of  natural  or  man-made 
fiber,  into  fabric  are  either  knitting  or 
weaving  or  a  combination  of  the  two. 

Most  knitting  is  of  the  circular  variety — 
that  is,  the  knit  material  forms  a  cylinder. 
The  diameter  of  this  cylinder  may  vary 
from  y%  inch  to  36  inches,  depending  upon 
the  product  being  manufactured.  In  figure 
4  a  knitter  in  a  seamless  hosiery  mill  can 
be  seen  checking  a  stocking  from  a  knit- 
ting machine.  This  machine  has  the  same 
basic  design  as  one  knitting  wider  and 
heavier  materials. 


Weaving,  the  major  industrial  use  of 
yarns  in  addition  to  knitting,  can  be  divided 
into  broad  and  narrow  woven  products.  An 
example  of  a  broad  woven  product  is  bed 
sheeting ;  of  a  narrow  woven  product,  cloth 
tape. 

In  either  process,  the  loom  must  be  sup- 
plied with  warp.  In  figure  5  a  worker  is 
seen  inspecting  the  transfer  of  yarn  from 
hundreds  of  packages  or  cheeses,  on  a  rack 
called  a  creel,  to  the  wide  cylinder  in  the 
warper  called  the  beam.  The  beam  is  then 
transferred  to  the  loom  (See  fig.  6). 

The  beam  furnishes  the  warp,  whether 
the  loom  is  a  narrow-fabric  machine  or  a 
broad  loom.  In  figure  6  a  narrow-fabric 
machine  or  loom  is  seen.  The  warp  ends  are 
brought  up  from  the  beam  and  down  to  the 
harness,  where  they  emerge  to  meet  the 
shuttles  carrying  the  cross  threads  or  fill- 
ing ends.  The  principle  involved  in  the 
broad  loom  is  the  same.  Instead  of  many 
small  shuttles  and  the  resulting  narrow 
tapes,  one  large  shuttle  is  used,  making  a 
wide  roll  of  cloth,  or  cut. 


374 


NORTH   CAROLINA    MEDICAL  JOURNAL 


September,  1960 


Fig.  5.  Warper. 

'Phis  operator  is  observing  the  transfer  of  yarns 
from  the  creel  to  the  beam  in  a  warper.  He  must 
possess  a  high  degree  of  visual  accuity  and  depth 
perception,  an  experienced  tactile  sense  to  piece 
ends  together,  and  a  stable  back  to  remain  at  po- 
sitions of  slight  flexion  in  performing  his  work. 
(Courtesy,  Employment  Security  Commission  of 
North   Carolina.) 


Fin  ish  ing  Operations 

We  come  now  to  the  finishing  or  com- 
pletion operations  of  the  textile  product. 
One  of  these,  performed  by  thousands  of  tex- 
tile employees  each  day,  is  looping.  This  is 
the  closing  of  the  toe  in  the  stockings,  men's 
socks,  children's  socks,  doll  socks,  and  so 
forth,  when  the  sock  has  been  knit  as  a 
cylinder  of  fabric  open  at  both  ends  (fig. 
4 ) .  This  work  may  be  done  prior  to  dyeing, 
or  it  may  be  performed  on  socks  knit  with 
yarn  that  is  pre-dyed.  The  looping  dial  is 
built  to  mate  the  knitting  needle  intervals, 
and  may  have  points  ranging  from  12  per 
inch  to  40  per  inch  (fig.  7). 

Whether  fabric  for  the  lining  of  your 
next  suit  or  fabric  for  your  next  car  or 
your  child's  pajamas,  the  woven  and  knit 
fabrics  must  be  put  in  an  attractive,  useful, 
durable  form. 

Treatment  of  fabrics  by  chemicals  and 
heat  play  an  important  role  in  this  condi- 
tioning. In  finishing  mills  large  vats  or 
tanks  called  kiers  are  filled  with  hundreds 
of  feet  of  woven  material.  This  material 
is  steeped  with  chemicals  or  enzymes  for 
varying  periods  of  time,  then  emptied  by 
power  equipment  for  washing  and  further 


dyeing  and  finishing 
momentary  repair  of 
of  a  fabric  coming 
washer. 

The   final    dyeing   of 
yarns    is    accomplished 


Figure  8  shows  the 
a  break  in  the  strand 
from    a    kier    to    the 


fabrics    as    well    as 
by   the  addition    of 


r 

Finished 

WOVEN 

NARROW 
FABRIC 


LOOM    ARCH 


-HARNESS 


Filling  ends 

FROM  QUILLS 
ONE  TO  EACH-' 
SHUTTLE 


Fig.  6.   Weaver. 

This  man  is  responsible  for  three  looms.  His  main  activity  is  walking,  moving  constantly  between  the 
machines  to  inspect  the  operation,  repairing  ends  when  breaks  occur  in  both  the  warp  and  the  filling  ends. 
Visual  acuity  of  a  high  degree  is  essential,  as  is  a  normal  tactile  sense  in  the  fingers.  Excellent  range 
of  motion  in  all  joints  assures  easy  operation  of  the  loom.  Back  flexion  is  extremely  important  for  the 
requirements  of  reaching  the  warp  ends.  Lifting  is  minimal  in  this  operation.  Most  weaving  does  not  re- 
quire the  weaver  to  remove  or  doff  the  finished  take-up  reel  or  cut.  This  operation  is  assigned  to  other 
employees. 


September,  1960  PHYSICAL  FACTORS   IN  TEXTILE  INDUSTRIES— GUNN  375 

LAMP 
fp==J 

LOOP 


Fi^.  7.   Lcoper. 

This  operation — placing  the  stocking  or  sock  on  its  "points"  in  the  only  correct  position — is  extremely 
delicate  and  exacting.  The  dial  revolves  (here  clockwise)  slowly  while  the  fabric  is  applied.  The  final 
stitching  and  cutting  of  the  now  useless  loop  from  the  foot  of  the  stocking  is  accomplished  by  mechan- 
ical means  as  it  makes  its  tour  around  the  dial,  until  the  operator  removes  the  stocking,  completed,  in 
front  of  her. 

This  work  is  done  in  a  sitting  position.  It  requires  a  high  degree  of  visual  acuity  with  an  accompany- 
ing ability  to  converge  easily  (esophoria)  and  excellent  depth  perception.  Tactile  sensibility  is  of  great 
importance.   Emotional    stability    must    be    considered    in  any  list  of  prerequisites. 


MERROvd  i] 

CO(J     WHEELS)    J~" 


FROM    THE 

BLEACHING 

KIER. 


Fig.  8.  Kier  Boiler. 

The  textile  worker,  on  the  right,  a  kier  boiler,  weighs  bleaching  chemicals  and  by  virture  of  the  opera- 
tion, works  in  an  atmosphere  of  higher  humidity  and  heat  than  that  generally  prevailing  throughout  the 
plant.  The  skin  of  these  workers  should  be  free  of  recurring  infections  and  free  of  hypersensitivity  to 
foreign  materials.  Strong  muscles  and  a  stable  back  are  essential  to  the  effective  operation  of  the  lid  on 
the  kier  tank  and  to  turning  the  large  valves  in  the  piping  system. 


dyestuffs  to  water  at  high  temperatures. 
This  creates  an  environment  similar  to  that 
of  the  bleaching  operation  just  described. 
Figure  9  shows  a  piece-dye  kettle  operator 
beside  his  machine  in  a  broad  woven  fabric 
mill  during  a  dye  run. 

Comment 

Here,  in  summary,  is  a  view  of  textile 
manufacturing  from  yarn  to  finished  fab- 
ric.  No  summary  would  be  complete  with- 


out the  final  step:  apparel  manufacturing. 
In  order  to  prevent  raveling  of  the  cut  ma- 
terial, an  overedger  or  serger  applies,  by 
machine,  a  whipped  stitch.  This  operation 
is  performed  before  the  garment  is  assem- 
bled on  a  sewing  machine   (fig.  10). 

Summary 

A   brief  description    of    textile    manufac- 
turing and  the  work  requirements  of  repre- 


37C 


NORTH    CAROLINA    MEDICAL   JOURNAL 


September,   I960 


CYLINDER 


^-MOVABLE 
I     /  DOOR. 

'  4+UKAPS' 


Fig.   9.   Piece  Dye   Kettle  Operator. 

The  taffy-like  strands  are  long  segments  of  80  yards  rolled  over  a  reel  and  rotated  at  medium  speed 
through  the  dye  bathe.  The  operator  is  responsible  for  four  machines,  for  measuring  the  chemicals 
placed  in  each  load,  for  placing  the  cloth  on  the  reel,  and  keeping  records  of  each  lot.  Note  that  he  is 
wearing  shoe  covers  for   protection   from   the   moisture  normally    present  in  such   operations. 


Fig.    10.    Sergers    (Overedgers). 

Sergers,  or  overedgers,  overcast  the  raw  edge 
of  cloth  to  prevent  raveling.  This  is  a  job  re- 
quiring good  manipulative  ability,  agility  of  hands 
and  fingers,  good  visual  acuity,  and,  as  with  loop- 
ing, emotional  stability.  (Courtesy,  Employment 
Security    Commission   of   North    Carolina.) 


sentative  jobs  in  this  industry  has  been  pre- 
sented. It  is  hoped  that  this  will  create  ad- 
ditional understanding  of  the  textile  indus- 
try and  of  the  work  performed  by  our  pa- 
tients in  this  industry. 

Acknowledgements 

Grateful  acknowledgement  in  the  preparation  of 
this  paper  is  to  be  given  to  Dr.  William  Wilson, 
Occupational  Health  Section,  State  Board  of 
Health,  Raleigh,  N.  C;  Mr.  Ted  Davis,  Employ- 
ment Security  Commission,  Raleigh,  N.  C;  Dr. 
J.  M.  Hall,  Elkin,  N.  C;  Dr.  Ben  Pulliam,  Mr. 
Arnold  Aspden,  Mr.  C.  Zell  Taylor  and  Mr.  H.  C. 
Woodall,   Jr.,  all   of  Winston-Salem. 

References 

1.  The  Employment  Security  Commission,  Quarterly,  Winter- 
Spring,    1959. 

2.  North  Carolina  Employment  and  Wages  195N,  Employ- 
ment Security  Commission  of  North  Carolina.  August, 
1959. 


September,  1960 

The  Governor's  Council  on  Occupational  Health 

A  Medium  of  Cooperative  Effort  for  the  Health  of  the  Worker 


377 


William  P.  Richardson, 
Chapel  Hill 


.D. 


In  every  period  medicine  has  to  face  the 
problem  of  a  twofold  adaptation.  On  the  one 
hand  it  must  adjust  to  changes  and  develop- 
ments in  the  social  and  economic  order,  and 
on  the  other  hand  it  must  find  new  ap- 
proaches and  methods  for  making  available 
new  or  improved  medical  services  which  have 
been  made  possible  through  scientific  and 
technological  advances.  It  is  customary  for 
each  generation  to  think  its  problems  and  de- 
velopments are  the  greatest  of  any  period  of 
history,  and  we  in  the  mid-twentieth  century 
are  no  exception.  Whether  or  not  this  is 
really  true,  it  cannot  be  denied  that  the  pace 
of  the  developments,  both  social  and  scien- 
tific, to  which  we  must  adapt  is  more  rapid 
than  in  previous  periods  and  that  it  is  pick- 
ing up  speed  all  the  time.  With  the  accele- 
rated pace  of  change  it  becomes  increasingly 
difficult  and  increasingly  important  to  de- 
velop sound  modes  of  adaptation  which  pre- 
serve the  enduring  values  and  principles  that 
have  always  guided  our  profession. 

One  of  the  unique  characteristics  of  the 
changes  of  the  past  few  decades  has  been 
the  fact  that  they  brought  into  the  picture  of 
medical  care  and  medical  service  not  only 
many  professional  workers  other  than  phy- 
sicians, but  also  a  variety  of  agencies  and 
institutions.  This  is  making  it  necessary  for 
the  physician  to  develop  a  whole  new  set  of 
relationships,  and  to  learn  to  carry  out  many 
of  his  functions  on  a  cooperative  basis  with 
the  various  members  of  what  is  often  called 
the  "health  team,"  with  hospitals,  and  with 
those  organizations  and  agencies  which  we 
have  termed  third  parties. 

Occupational  health  programs,  as  they 
have  evolved  and  continue  to  evolve,  repre- 
sent an  adaptation  to  the  special  needs  cre- 
ated by  expanded  industrialization,  which 
has  concentrated  workers  into  large  groups 
and  exposed  them  to  the  hazards  of  increas- 
ingly complex  technical  procedures  and  a 
rapidly  growing  assortment  of  new  and  un- 


*Read  before  the  Section  on  General  Practice  of  Medicine, 
Medical  Society  of  the  State  of  North  Carolina,  Raleigh,  May 
11,    1960. 

From  the  Department  of  Preventive  Medicine,  University  of 
North    Carolina    School    of    Medicine,    Chapel    Hill. 


familiar  chemical  and  physical  agents.  The 
presently  accepted  pattern  of  occupational 
health  programs  is  an  achievement  in  which 
both  the  medical  profession  and  our  indus- 
trial society  can  take  genuine  pride.  Its  de- 
velopment has  not  been  easy.  There  have 
been  difficulties,  differences  of  opinion  and 
controversy,  but  after  all  that  is  the  way 
most  worthwhile  achievements  are  made.  The 
significant  thing  is  that  we  have  developed 
a  philosophy,  a  set  of  principles,  and  a  pro- 
gram which  have  met  with  the  official  ap- 
proval of  organized  medicine  and  of  the  busi- 
ness and  industrial  community,  and  which, 
as  understanding  of  them  spreads,  are  gain- 
ing the  warm  support  of  the  rank  and  file  of 
both  groups. 

The  other  speakers  are  dealing  with  the 
way  occupational  health  programs  are  or- 
ganized and  operate,  and  the  services  they 
provide.  The  feature  of  these  programs  I 
would  like  to  stress,  because  it  forms  the 
basis  for  the  whole  idea  of  an  occupational 
heath  council,  is  the  number  of  individuals 
and  agencies  involved  in  protecting  and  pro- 
moting the  health  of  the  worker,  and  the  re- 
sulting importance  of  close,  cooperative  rela- 
tionships among  them,  based  on  principles 
and  objectives  understood  and  accepted  by 
all  parties  of  the  program. 

Growth  of  the  Occupational  Health 
Movement  in  North  Carolina 

Those  of  us  who  have  been  close  to  de- 
velopments in  occupational  health  in  North 
Carolina  feel  that  significant  and  heartening 
progress  has  been  made  over  the  past  several 
years.  A  very  important  beginning  was  made 
when  several  able,  highly  intelligent,  and 
enthusiastic  young  men  entered  this  field  of 
practice  in  the  state,  and  no  account  of  de- 
velopments would  be  complete  without  tri- 
bute to  the  splendid  contributions  these  men 
have  made  by  their  enthusiastic  demonstra- 
tion and  promotion  of  what  constitutes  good 
occupational  health  practice  and  what  it  can 
accomplish. 

While  the  state  medical  society  has  had 
a  committee  in  the  field  of  industrial 
health    since    1934,    it   was   primarily    con- 


378 


NORTH    CAROLINA    MEDICAL  JOURNAL 


September,   1960 


cerned  with  problems  referred  to  it,  in 
the  main  related  to  the  Industrial  Com 
mission.  The  first  special  effort  by  the  so- 
ciety to  stimulate  interest  and  understanding 
in  this  field  was  an  industrial  health  seminar 
held  at  Chapel  Hill  in  February,  1954,  spon- 
sored jointly  by  the  University  of  North 
Carolina  School  of  Medicine  and  the  society's 
Committee  on  Industrial  Health  under  the 
leadership  of  Dr.  Harry  L.  Johnson.  This 
seminar  became  an  annual  event,  and  in  sub- 
sequent years  was  expanded  to  include  a  half 
day  devoted  to  subjects  of  interest  to  repre- 
sentatives of  business  and  industry  and  of- 
ficials of  state  agencies  having  responsibili- 
ties related  to  industrial  health  and  safety, 
as  well  as  to  physicians. 

Out  of  these  expanded  seminars  grew  the 
suggestions  for  a  state  conference  on  occu- 
pational health  sponsored  by  Governor 
Hodges,  and  bringing  together  all  who  might 
have  interest  or  responsibilities  in  the  field : 
physicians,  nurses,  engineers,  public  health 
workers,  officials,  legislators,  and  as  wide  a 
representation  as  possible  from  business  and 
industry  in  the  state.  The  first  Governor's 
Conference  on  Occupational  Health  was  held 
in  January,  1957,  and  those  attending  ap- 
proved a  strong  recommendation  for  a  per- 
manent council  on  which  all  the  interested 
professions  and  groups  would  be  represented. 
As  a  result  of  this  recommendation  and  of 
Governor  Hodges'  interest  and  support,  a 
steering  group  was  formed  to  plan  an  or- 
ganizational meeting  and  to  lay  the  ground- 
work for  selection  of  members.  This  group 
was  composed  of  the  Committee  on  Occupa- 
tional Health  of  the  State  Medical  Society, 
representatives  of  the  State  Board  of  Health, 
the  Department  of  Labor,  the  Industrial 
Commission,  the  Vocational  Rehabilitation 
Division  of  the  Department  of  Public  In- 
struction, the  University  of  North  Carolina 
Schools  of  Medicine  and  Public  Health,  and 
two  invited  representatives  from  industry. 

The  preliminary  planning  took  almost  a 
year  and  a  half.  Largely  from  a  list  of  names 
suggested  by  the  steering  group.  Governor 
Hodges  asked  42  people  to  serve  on  the  Coun- 
cil. In  making  the  appointments,  representa- 
tion was  provided  from  the  medical,  nursing 
and  engineering  professions,  from  the  vari- 
ous state  agencies  concerned,  from  labor,  and 
from  a  cross  section  of  business  and  industry 
in  the  state,  including  large  and  small  busi- 
ness and  all  the  major  industrial  and  busi- 


ness fields.  An  enthusiastic  organizational 
meeting  was  held  in  July,  1958.  The  present 
membership  is  44,  including  13  physicians. 
This  number  will  be  enlarged  somewhat  in 
the  near  future  as  a  result  of  action  taken 
at  the  last  meeting  of  the  Council  to  add  rep- 
resentation from  the  dental  profession,  the 
Department  of  Agriculture,  and  the  Agricul- 
tural Extension  Service. 

Objectives  and  Functions  of  the  Council 

You  will  be  interested  in  the  objectives  of 
the  Council  as  stated  in  the  by-laws.  These 
are: 

1.  To  promote  interest  in  all  phases  of 
employee  and  worker  health  in  North 
Carolina. 

2.  To  provide  an  effective  means  for  co- 
operation and  interchange  of  informa- 
mation  among  all  the  agencies  and 
groups  interested  in  the  problems. 

3.  To  promote  study  of  special  hazards  to 
employee  health  which  may  exist  in 
North  Carolina. 

4.  To  promote  the  development  of  practi- 
cal programs  by  which  small  business 
and  industrial  establishments  and  ag- 
ricultural employers  may  provide 
health  services  for  their  employees. 

5.  To  interpret  to  the  officials  and  citizens 
of  the  state  the  needs  and  accomplish- 
ments in  the  occupational  health  field 
in  North  Carolina. 

6.  To  sponsor  an  annual  Governor's  con- 
ference on  occupational  health. 

Perhaps  the  most  significant  function  of 
the  Council,  as  distinguished  from  its  over- 
all objective  of  promoting  the  health  of  work- 
ers, is  indicated  by  the  second  objective,  that 
of  providing  an  effective  means  for  coopera- 
tion and  interchange  of  information  among 
all  who  have  a  concern  for  and  a  part  in  the 
protection  and  promotion  of  worker  health. 
Physicians  and  nurses,  of  course,  have  a  tra- 
dition of  working  together,  but  heretofore 
there  has  been  too  little  opportunity  to  de- 
velop mutual  understanding  between  busi- 
ness and  industrial  management  and  the 
health  professions,  between  physicians  and 
safety  engineers,  or  between  all  of  these 
groups  and  the  several  official  agencies  con- 
cerned with  industrial  health  and  safety.  The 
Council  supplies  a  medium  where  these 


September,  1960 


OCCUPATIONAL   HEALTH    COUNCIL— RICHARDSON 


379 


groups  can  come  together  and  become  fa- 
miliar with  each  other's  points  of  view  and 
problems  and  can  direct  their  efforts  toward 
the  development  of  more  effective  coopera- 
tion in  promoting  the  health  of  the  working 
population. 

The  establishment  of  such  a  forum  for 
communication  and  exchange  of  ideas  is  in 
itself  a  significant  development.  As  society 
gets  more  complex,  the  problem  of  commun- 
ication between  various  groups  which  may 
impinge  on  each  other  becomes  increasingly 
difficult.  The  Council  with  its  broad  repre- 
sentation provides  a  forum  where  thought- 
ful consideration  can  be  given  to  the  prob- 
lems and  ideas  of  each  group,  and  some  mu- 
tual understandings  achieved.  Through  the 
annual  Governor's  Conference  we  have  a 
broader  forum,  since  the  conference  is  open 
to  all,  and  aims  for  a  large  and  representa- 
tive attendance. 


Current  Projects 

Handbook  on  occupational  health 

Because  the  Council  is  new  we  have  no 
completed  accomplishments  to  report,  but 
two  of  the  projects  presently  under  way  are 
of  particular  interest  to  this  group.  The  first 
is  a  North  Carolina  handbook  on  occupa- 
tional health.  This  should  be  a  valuable 
source  of  information  for  all  concerned  with 
the  subject,  but  especially  for  physicians  do- 
ing part-time  industrial  practice,  and  for 
management,  which  wants  to  know  what 
legal  requirements  it  must  meet,  to  what 
sources  it  can  turn  for  consultation  and  help, 
and  what  are  approved  patterns  of  health 
services  for  employees.  It  should  also  be  of 
significant  interest  to  industrial  and  business 
concerns  considering  locating  in  North  Caro- 
lina. It  will,  of  course,  be  given  wide  distri- 
bution. Most  of  the  material  has  been  assem- 
bled, and  it  is  hoped  the  completed  handbook 
will  be  available  by  the  time  the  Annual  Con- 
gress on  Industrial  Health  of  the  A.M. A, 
meets  in  Charlotte  in  October. 

Services  to  small  plants 

The  second  project  is  a  study  of  possible 
means  of  providing  health  services  to  em- 
ployees of  establishments  too  small  to  have 
any  kind  of  full-time  service  of  their  own. 
Occupational  health  programs  are  being  de- 
veloped by  an   increasing  number  of  large 


industries,  but  approximately  9 1  per  cent  of 
North  Carolina  establishments  have  fewer 
than  500  employees,  and  nearly  80  per  cent 
have  100  or  fewer  employees.  It  is  clear, 
therefore,  that  if  the  majority  of  our  state's 
workers  are  to  have  the  benefits  of  such  serv- 
ices, some  plan  for  providing  them  other 
than  the  conventional  in-plant  medical  de- 
partment will  have  to  be  devised.  It  is  equally 
clear  that  any  effective  plan,  generally  ap- 
plied, will  involve  participation  by  most  of 
the  general  practitioners  of  the  state  devot- 
ing some  time  to  occupational  practice. 

As  you  perhaps  know,  there  are  a  number 
of  so-called  small  plant  services  which  have 
attracted  considerable  attention.  We  have 
had  people  from  some  of  them  talk  at  our 
Governor's  Conference.  These  services  are 
excellent,  and  represent  imaginative  solu- 
tions of  particular  situations.  The  trouble 
is,  the  establishments  they  serve,  while  meas- 
ured in  hundreds  of  employees  rather  than 
thousands,  are  still  much  larger  than  those 
which  constitute  the  largest  segment  of  our 
need  in  North  Carolina.  It  is  worth  noting 
that  the  health  hazards  and  problems  in 
small  establishments  are  proportionately 
greater  than  those  in  larger  ones.  Coming 
up  with  a  practical  approach  to  this  need 
is  one  of  the  challenges  we  face,  and  it  is 
one  to  which  the  Council  is  addressing  itself. 

Conclusion 

We  may  summarize  this  discussion  with 
four  points  which  I  think  deserve  emphasis : 

1.  The  formation  of  the  Governor's  Coun- 
cil on  Occupational  Health  is  but  the  most 
recent  in  a  succession  of  developments  mark- 
ing the  growth  of  appreciation  for  and  in- 
terest in  employee  health  services  in  North 
Carolina. 

2.  The  Council  offers  an  excellent  medium 
for  communication  and  cooperation  among 
all  those  concerned  with  this  field. 

3.  It  is  inaugurating  activities  which 
should  make  significant  contributions  to  fur- 
ther progress. 

4.  The  ultimate  success  of  the  Council  and 
the  solution  of  the  problem  of  occupational 
health  services  for  the  majority  of  our  state's 
workers  will  require  the  understanding,  in- 
terest, and  participation  of  the  practicing 
physicians  of  the  state. 


::xu 


NORTH    CAROLINA    MEDICAL  JOURNAL 


September,  1960 


Clinical  Evaluation  of  the  Antacid  Properties 
of  Hydrated  Magnesium  Aluminate 


David  Cayer,  M.D. 

and 

M.  Frank  Sohmer,  M.D. 

Winston-Salem 


Benign  peptic  ulcers  do  not  occur  in  pa- 
tients with  permanent  achlorhydria.  In  those 
patients  having  active  duodenal  ulcers,  gas- 
tric hypersecretion  is  invariably  present. 
The  relationship  between  ulcer  and  acid  is 
well  established,  although  no  definite  corre- 
lation between  the  degree  of  acidity,  the  se- 
verity of  ulcer  symptoms,  and  ulcer  activity 
has  been  demonstrated.  Clinically,  antacid 
agents  provide  symptomatic  relief. 

General  Principles  of  Antacid  Therapy 

The  efficacy  of  an  antacid  depends  upon 
(1)  the  quantity  of  acid  bound,  (2)  the 
speed  of  buffering,  (3)  the  duration  of  ac- 
tion, and  (4)  the  rate  of  gastric  emptying. 
The  effect  of  acid-neutralizing  drugs  on  gas- 
tric secretions  is  also  influenced  by  (1)  the 
amount  of  drug  administered,  (2)  the  phase 
of  digestion,  and  (3)  the  presence  or  ab- 
sence of  disease. 

Free  acid,  usually  defined  as  being  present 
at  pH  levels  below  2.8,  is  considered  respon- 
sible for  the  digestive  effect  of  gastric  juice. 
At  pH  levels  above  2.8  the  proteolytic  ac- 
tivity of  pepsin  is  greatly  reduced.  A  pH 
in  the  range  of  3.5  to  5.5  is  regarded  as 
favorable  for  ulcer  healing.  Levels  above 
pH  7  may  lead  to  "rebound"  stimulation  of 
gastric  secretion,  and  are  generally  consid- 
ered undesirable. 

The  ideal  antacid  preparation  would  be 
one  that  is  nonirritating  and  can  be  used  in 
small  doses  to  neutralize  large  amounts  of 
gastric  juice  promptly  and  for  prolonged 
periods.  It  should  not  cause  systemic  alka- 
losis, produce  a  rebound  stimulation  of  acid 
secretion,  interfere  with  digestive  processes, 
induce  diarrhea  or  constipation,  nor  release 
carbon  diovide  on  reacting  with  hydrochloric 
acid. 


Studies  of  Hi/drated  Magnesium  Aluminate 
We  have  recently  studied  a  new  type  of 
antacid  produced  by  the  chemical  union  of 
aluminum  hydroxide  and  magnesium  hydrox- 
ide, two  of  the  most  widely  used  antacids. 
The  resulting  compounds,  hydrated  magne- 
sium aluminate*,  is  a  uniform,  stable  white 
powder,  which  can  be  prepared  both  as  a 
tablet  and  as  a  gel. 

In  vitro  studies 

In  contrast  to  the  previously  described 
magnesium  aluminates  in  which  the  ratio  of 
magnesium  to  aluminum  is  always  1 :2,  hy- 
drated magnesium  aluminate  has  a  magne- 
sium-aluminum-water ratio  of  4:2:9.  The 
in  vitro  action  of  this  complex  differs  mark- 
edly from  that  of  equivalent  physical  mix- 
tures of  magnesium  and  aluminum  hydrox- 
ide, producing  more  favorable,  less  scattered 
pH  values  within  the  therapeutically  desired 
range  of  3.5  to  5.5,  and  maintaining  such 
levels  for  40  to  60  minutes  (fig.  1).  The 
use  of  an  equivalent  physical  mixture  of  mag- 
nesium and  aluminum  hydroxide  produces 
widely  scattered  pH  values  outside  the  thera- 
peutically desirable  range,  with  less  sus- 
tained buffering  action. 

The  magnesium  aluminate  hydrate  reacts 
promptly  with  gastric  hydrochloric  acid  to 
form  aluminum  hydrochloride  gel  and  mag- 
nesium chloride,  each  with  an  acid-binding 
effect. 

The  relative  acid-combining  capacities!  of 
hydrated  magnesium  aluminate  and  other 
antacids,  in  terms  of  the  amount  of  0.1  nor- 
mal hydrochloric  acid  neutralized  per  gram, 
are  as  follows : 


U.S. P.   aluminum  hydroxide    (dry  gel) 
Magnesium  aluminate  hydrate 
Dihydroxy  aluminum  sodium  carbonate 
Magnesium  trisilicate 
Sodium   bicarbonate 


254  cc. 

247  cc. 

238  cc. 

140  cc. 

120  cc. 


From  the  Department  of  Medicine  of  the  Bowman  Gray 
School  of  Medicine  of  Wake  Forest  College,  Winston-Salem. 
North    Carolina. 


'Supplied  as  Riopan  (400  mg,  tablets)  through  the  cour- 
tesy  of   Ayerst   Laboratories. 

■  Determined  by  stirring  aliquots  of  the  substance  with  ex- 
cess 0.1  normal  hydrochloric  acid  at  37  C.  for  one  hour, 
and    back    titrating    the    excess    acid. 


September,  1960       HYDRATED   MAGNESIUM   ALUMINATE— CAYER  AND   SOHMER 


3S1 


Effect  of  the  Maximum  Recommended  Dosage  on  the  pH  of  100  cc  N/100  HCI. 
(tablets  added  as  an  80  mesh  pomder) 
70r 


7.--*""' 


pH  4  0  -j 


0     10    20         40 


60  90  120 

TIME  (Seconds) 


I. Aluminum  hydroxide  gel   with  magnesium  hydroxide  -  2  Tablets 

2. Aluminum  hydroxide  gel  -  2  Tablets 

3.  Aluminum  hydroxide  gel  (4  grains)  and  magnesium  trisilicate 

(71/,  groins)  -  2  Tablets 

4. Magnesium  and  aluminum  hydroxide  -  4  Tablevs 

5. Reactive  aluminum   hydroxide  -  4  Tablets 

6.  —   Hydraled  magnesium  aluminate  (AY-5710,  "RIOPAN'1-400  mg/ 

tablet -4  Tablets 

7.  Magnesium   trisilicate,  calcium  carbonate   and  magnesium 

hydroxide  -  4  Tablets 

6. Calcium  carbonate  prec,  magnesium  carbonate  and  mognesium 

trisilicate  -4  Tablets 

Figure  1 

The  acid-combining  capacity  and  speed  of 
action  of  hydrated  magnesium  aluminate  are 
compared  with  those  of  other  antacids  in 
figure  1.  It  can  be  seen  that  the  hydrated 
magnesium  aluminate  caused  a  rapid  eleva- 
tion of  pH  levels  above  3,  and  sustained  buf- 
fering capacity. 

In  vivo  studies 

Studies  of  gastric  acidity  were  made  on 
10  patients — 9  men  and  1  woman — with  ac- 
tive duodenal  ulcers.  All  had  evidence  of 
gastric  hypersecretion,  and  most  of  the 
initial  acid  values  were  in  the  upper  range 
of  normal   (figure  2). 

In  4  patients  who  received  2  tablets  of 
magnesium  aluminate  hydrate,  buffering  ac- 
tion was  demonstrable  for  45  to  90  minutes. 
Six  patients  were  given  4  tablets  in  a  single 
dose.  In  these  patients,  a  buffering  effect 
was  demonstrable  for  periods  ranging  from 
30  to  120  minutes. 

In  4  patients  specimens  of  gastric  secre- 
tion were  taken  15  minutes  after  administra- 
tion of  2  tablets  of  the  drug.  In  one  patient 
no  buffering  effect  was  demonstrable,  but  in 
the  other  3  achlorhydria  was  present. 

In  the  majority  of  patients  effective  buf- 
fering was  present  for  one  to  two  hours.  In 
those  patients  having  pain  at  the  time  the 
tablets  were  administered,  relief  was  prompt 
and  sustained.  The  average  pH  determina- 
tions of  gastric  specimens  are  shown  in 
figure  2. 


Average 

7.0 

6.0 

5.0 
4  0 
3.0 
2.0 
1.0 


Ph.  Value  of  Gastric  Juice  in  10  Peptic  Ulcer  Patients 


Before    400  mq.  hydraled  magnesium  aluminate 

After        ■'        ' 

o" 

/                                """^x 

is  Jri! 

s     '"  > 
1          ~ 

- 

1 

• 

I* 

? 

i         i         i         i         i         i 

90 


15  30  45  60  75 

TIME  (Minutes) 

Figure  2 

Clinical  study 

The  clinical  study  was  conducted  in  72 
patients  —  55  men  and  17  women  —  with 
symptoms  of  peptic  ulcer.  The  diagnoses  in 
this  group  were  as  follows:  duodenal  ulcer 
(63),  channel  ulcer  (1),  marginal  ulcer  (3), 
duodenal  and  gastric  ulcers  (1),  duodenitis 
(1),  normal  roentgenogram  (2),  normal 
roentgenogram  but  with  past  history  of  ulcer 
(1).  The  patients  ranged  in  age  from  20  to 
72  years,  with  a  mean  age  of  45.  Twenty-five 
patients  had  a  past  history  of  hemorrhage. 
Six  patients  had  previously  required  surgery 
for  perforation  or  obstruction. 

Each  patient  had  had  peptic  ulcer  activity 
— as  indicated  by  the  history,  roentgen  find- 
ings, or  both — within  six  months  preceding 
the  study.  Fifty-three  of  the  patients  were 
considered  to  have  clinically  active  ulcers  at 
the  beginning  of  the  study.  The  duration, 
frequency,  and  severity  of  ulcer  symptoms 
were  determined  at  the  beginning  of  treat- 
ment. The  symptoms  were  considered  mild 
in  32  patients,  moderate  in  26,  and  severe 
in  14. 

The  medication  used  in  the  study  consisted 
of  2  tablets  of  hydrated  magnesium  alumi- 
nate given  two  hours  after  each  meal  and  at 
bedtime.  All  patients  were  seen  at  intervals 
of  four  to  six  weeks,  and  in  the  majority 
roentgen  examinations  were  made  at  the  be- 
ginning and  at  the  termination  of  the  study, 
one  year  later. 

Final  evaluation  of  results  was  based  on 
data  recorded  by  patients  and  on  the  clinical 
impression  of  the  investigator  at  each  fol- 
low-up visit.   The  results  were  classified  as 


382 


NORTH   CAROLINA    MEDICAL  JOURNAL 


September,  1960 


"good  to  excellent"  (freedom  from  ulcer  dis- 
tress throughout  the  period  of  observation, 
or  improvement  in  spite  of  recurrence)  or 
"fair  to  poor"  (exacerbation,  no  change,  or 
only  slight  improvement  with  continued  re- 
currences). Recurrences  were  classified  as 
"none,"  "fewer  and  milder,"  "same  or  more." 

Results:  Seven  patients  discontinued  the 
drug  —  4  because  they  were  asymptomatic, 
and  3  because  they  were  unimproved.  Two 
other  patients  had  a  recurrence  of  ulcer 
symptoms  after  they  ran  out  of  the  drug. 
The  only  adverse  effect  noted  was  mild  con- 
stipation in  2  cases.  None  of  the  patients 
who  discontinued  the  medication  considered 
side  effects  a  deterrent  to  therapy. 

Forty-nine  of  the  patients  (68  per  cent) 
had  good  to  excellent  results  (no  recur- 
rences in  35  per  cent,  fewer  or  milder  recur- 
rences in  33  per  cent),  while  32  per  cent 
were  unchanged  or  worse.  Two  patients  had 
hemorrhages  while  under  treatment,  and  2 
required  gastric  resections. 

Comment 

lu  the  clinical  study  of  72  patients,  no  evi- 
dence of  absorption  of  the  hydrated  magne- 
sium aluminate  was  noted  in  any  case.  There 
was  no  clinical  evidence  of  alkalosis,  disturb- 


ance of  electrolyte  balance,  severe  constipa- 
tion, catharsis,  or  any  other  significant  side 

effects. 

The  preparation  was  demonstrated  both 
-'//  rira  and  in  vitro  to  dh  o!\  ■  ra  idly  — 
within  15  minutes  in  human  patients.  This 
compound  was  able  to  buffer  lai  amounts 
of  gastric  acid  rapidly,  and  in  most  patients 
to  sustain  the  pH  of  the  stomach  at  levels 
between  3  and  5  for  approximately  60  min- 
utes. This  buffering  effect  was  manifested 
( linically  by  prompt  relief  of  pain.  At  no 
time  did  the  pH  values  rise  to  alkaline  levels. 

Summary 

Clinical  and  laboratory  studies  with  hy- 
drated magnesium  aluminate  indicate  the 
compound  to  be  a  potent  antacid  which 
rapidly  raises  the  pH  of  the  gastric  contents 
to  therapeutically  desired  levels,  which  are 
sustained  for  periods  of  an  hour  or  more. 

In  a  clinical  study  of  72  patients  with 
symptoms  of  peptic  ulcer,  no  evidence  of  ab- 
sorption, alkalosis,  or  disturbance  of  electro- 
lyte balance  was  noted.  In  the  dosage  used, 
the  compound  did  not  interfere  with  diges- 
tion, and  produced  virtually  no  side  effects. 
Results  were  considered  "good  to  excellent" 
in  68  per  cent  of  the  cases. 


Mail  Order  Prescription  Services 


H.  C.  McAllister* 
Chapel  Hill 


The  deceptive  lure  of  "price  discounts" 
has  been  the  bait  with  which  many  a  trap 
has  been  set.  The  latest  of  these  is  the  mail 
order  prescription  services  which  have  been 
springing  up  here  and  there  during  recent 
months.  The  development  of  these  unortho- 
dox schemes  of  supplying  medication  seems 
to  have  resulted  from  a  series  of  circum- 
stances. 

What  is  believed  to  be  the  first  plan  to 
offer  prescription  service  by  mail  is  that  de- 
veloped by  the  National  Association  of  Re- 
tired Teachers  and  the  American  Association 
of  Retired  Persons.  These  two  organizations 
worked  out  an  arrangement  with  a  local 
New  York  chain  drug  store  group  to  set  up 
outlets  for  their  members.    Two  mail  order 


From    the    Institute    of    Pharmacy.    Chapel    Hill. 
•Secretary-Treasurer    of    the    North    Carolina    Board    of    Phar- 
macy. 


depots  were  established — one  in  Washington, 
D.  C,  and  the  other  in  California.  The  lat- 
ter was  later  closed.  (It  is  understood  that 
it  failed  to  meet  the  requirements  of  the 
California  law.)  Another  outlet  has  been 
established  by  this  group  in  St.  Petersburg, 
Florida. 

As  a  result  of  the  newspaper  headlines 
stemming  from  the  reckless  and  misleading 
information  (more  properly  misinforma- 
tion) coming  out  of  the  Kefauver  Commit- 
tee hearings,  other  independent  mail  order 
prescription  services  have  sprung  up  in  Kan- 
sas City,  Missouri;  Brooklyn,  New  York; 
Seagoville,  Texas.  Another  organizational 
service  (Bakery  and  Confection  Workers 
Union)  has  been  established  in  Washington, 
D.  C.  The  last  mentioned  has  already  been 
in  municipal  court  for  a  hearing  resulting 
from  alleged  failure  to  comply  with  pharm- 


September,  1960 


MAIL  ORDER  PRESCRIPTION   SERVICES— MCALLISTER 


383 


acy,  sanitation,  and  fire  laws.  At  least  one 
inquiry  has  been  received  by  the  Board  of 
Pharmacy  concerning'  a  proposed  outlet  in 
North  Carolina.  Others  will  doubtless  be  es- 
tablished in  order  to  capitalize  on  the  favor- 
able atmosphere  created  for  them  by  the 
false  and  misleading  information  that  is  cur- 
rently being  spread  abroad  about  drug  prices. 

Dangers  and  Disadvantages 

Physicians  want  to  see  that  their  patients 
get  medication  as  economically  as  is  consis- 
tent with  good  quality.  It  is  only  proper  that 
they  should.  Economy,  however,  is  not  the 
only  consideration  that  must  be  taken  into 
account  in  the  treatment  of  illness  by  the  use 
of  drugs.  The  time  element  and  the  assur- 
ance of  proper  handling  are,  in  most  cases, 
considerably  more  important  to  the  physician 
and  the  patient  than  the  spurious  "savings" 
(which,  if  any,  are  small)  that  might  be  of- 
fered by  the  mail  order  mechanism.  From 
the  standpoint  of  the  physician — and  the  pa- 
tient— the  mail  order  prescription  schemes 
have  some  serious  disadvantages  about  which 
he — and  his  patient — should  be  informed. 

Unavoidable  delays 

The  present-day  physician  is  not  only  bet- 
ter equipped  to  diagnose  and  prescribe  than 
ever  before,  but  he  also  has  eminently  better 
medicinal  agents  to  meet  his  needs  than  has 
ever  been  the  case  in  the  past.  These  factors 
add  up  to  efficient  and  effective  treatment, 
as  proved  by  the  dramatic  reduction  in  the 
average  duration  of  most  illnesses.  To 
achieve  this  result,  however,  the  physician 
must  be  able  to  administer  the  remedy  indi- 
cated at  the  time  of  diagnosis — not  days  or 
weeks  later,  when  complicating  factors  may 
have  intervened,  quite  possibly  altering  the 
entire  rationale  of  treatment.  Allowing  for 
transportation  (both  ways),  filling,  ship- 
ping, and  so  forth,  the  very  minimum  time 
in  which  a  prescription  can  be  serviced  in 
Washington,  D.  C,  from  a  place  as  near  as 
North  Carolina  is  three  days.  Persons  who 
have  used  this  service  place  the  time  element 
from  ten  days  to  two  weeks.  One  cardiac 
patient  requested  the  return  of  her  prescrip- 
tion when  the  medication  had  not  been  re- 
ceived in  two  weeks. 

Translating  the  cost  of  the  minimum  de- 
lay of  three  days  into  terms  of  any  savings 
that  might  be  effected,  it  is  still  false  econ- 
omy for  the  patient.    Herein  lies  the  "trap" 


of  the  whole  mail  order  scheme.  Inherent 
in  the  lure  of  price  discounts  for  prescrip- 
tion service  is  the  idea  that  traditional  pre- 
scription services  are  rendered  at  a  premium 
price.  It  is  believed  that,  in  general,  physi- 
cians consider  prescription  prices  fair.  This 
is  not  as  well  understood,  however,  by  some 
of  their  patients. 

A  further  consideration  arising  from  the 
delay  in  the  delivery  of  the  preparation  is 
the  encouragement  of  self-medication.  Pend- 
ing arrival  of  the  prescribed  drug,  the  pa- 
tient has  a  strong  urge  to  treat  himself.  Here 
again  is  introduced  an  element  of  interfer- 
ence with  the  physician's  plan  of  treatment 

Forged  prescriptions 

A  serious  problem  encountered  with  the 
supply  of  drugs  through  the  mails  is  the 
verification  of  prescriptions.  There  is  no  way 
whereby  prescriptions  can  be  authenticated. 
As  a  test,  several  forged  prescription  for 
large  quantities  of  barbiturates  and  central 
nervous  system  stimulants  were  forwarded 
to  one  of  these  outlets.  In  due  time  the  drugs 
arrived  along  with  a  solicitation  of  future 
business.  Such  laxity  in  handling  prescrip- 
tions and  dangerous  drugs  not  only  provides 
a  made-to-order  opportunity  for  deviators  to 
obtain  drugs  for  illicit  traffic,  but  also  can 
prove  troublesome  for  the  physician  in  the 
management  of  patients  with  emotional 
problems  and  others  who  have  the  "medicine 
habit." 

Limited  service 

With  the  wide  variety  of  medicinal  prep- 
arations available  today,  doctors'  prescrip- 
tions require  less  compounding  than  they  did 
in  former  years.  There  are  occasions,  how- 
ever, when  compounding  is  necessary.  Such 
prescriptions  sent  to  the  mail  order  outlets 
have  been  returned  marked  "not  stocked." 

Suspicion  was  aroused  when  it  was  noted 
that  the  order  form  of  one  mail-order  outlet 
bore  an  entry  for  the  customer  to  indicate 
whether  he  wanted  his  prescription  filled 
with  the  organization's  "generic  equivalent" 
of  the  drug  ordered,  on  the  assumption  that 
this  substitute  would  be  cheaper  than  the 
genuine  article.  This  indicates  that  the  mail 
order  company  is  willing  to  substitute  its 
judgment  in  determining  the  brand  of  drug 
supplied  for  that  of  the  doctor  who  ordered 
it.  Evidently  this  item  became  troublesome, 
since  it  has  now  been  dropped  from  the  order 


384 


NORTH   CAROLINA    MEDICAL   JOURNAL 


September,  I960 


form.  One  continues  to  wonder,  however,  if 
a  specified  brand  drug  will  be  furnished  or 
whether  the  prescription  will  be  filled  with  a 
so-called  "generic  equivalent"  of  undeter- 
mined origin. 

There  is  yet  other  evidence  of  the  limited 
service  performed  by  the  mail  order  com- 
panies. A  prescription  calling  for  30  tablets 
of  a  drug  and  marked  with  two  refill  authori- 
zations was  filled  with  the  manufacturer's 
original  bottle  of  100  tablets  and  returned 
with  the  explanation  that  they  were  "cheaper 
by  the  hundred." 

Inaccessibility  of  prescription  files 

What  is  perhaps  one  of  the  most  dangerous 
aspects  of  a  mail  order  prescription  service 
is  the  inaccessability  of  prescription  files  for 
use  during  emergencies  resulting  from  idio- 
syncrasies or  the  accidental  ingestion  of 
drugs  by  persons  other  than  those  for  whom 
they  were  prescribed.  No  one  knows  better 
than  the  physician  how  essential  it  is  to 
identify  the  drug  that  little  Johnnie  drank 
while  mother's  back  was  turned.  Time  is  of 
the  essence  in  determining  whether  extreme 
measures  shall  be  taken,  as  in  the  case  of 
potent  drugs,  or  whether  simple  procedures 
and  assurances  to  the  mother  are  adequate, 
as  in  the  case  of  the  less  potent  preparations. 
Then  there  is,  of  course,  the  occasional  ana- 
phylactic reaction  wherein  the  identification 
of  the  antigen  is  essential  or  will  materially 
assist  in  proper  treatment. 

Question  of  Legality 

There  is  a  serious  question  as  to  whether 
the  mail  order  distribution  of  drugs  is  a  legal 
operation.    Individual  states  have  the  right 


to  exercise  police  power  for  the  protection 
of  the  health,  safety,  welfare,  and  morals  of 
their  citizens.  It  is  through  the  use  of  this 
power  that  the  health  professions  are  regu- 
lated. The  states  have  exclusive  jurisdiction 
over  matters  of  professional  practice  and 
privilege.  Neither  the  federal  government 
nor  any  other  extraterritorial  body  can  or 
does  confer  professional  license  and  privilege 
upon  a  person  within  a  state.  State  laws  re- 
lating to  professional  practice  and  privilege 
are  administered  by  specialized  boards  or 
agencies.  These  boards  exercise  jurisdiction 
only  within  their  own  state.  Their  activities 
are  designed  to  protect  the  people  in  that 
particular  state  against  ignorance  and  in- 
competency. Similarly,  a  professional  license 
in  one  state  does  not  entitle  the  holder  to 
practice  elsewhere. 

This  situation  poses  the  question  of 
whether  or  not  the  mail  order  mechanism 
constitutes  the  practice  of  pharmacy  in 
North  Carolina.  Certainly  the  Board  of 
Pharmacy  cannot  inspect  these  outlets  to  de- 
termine whether  pharmaceutical  services  are 
being  performed  by  qualified  persons  or 
whether  other  requirements  of  North  Caro- 
lina law  are  being  met.  The  distributors  hold 
no  professional  license  in  the  state  against 
which  the  Board  might  proceed,  nor  are  they 
available,  without  extradition  proceedings, 
for  other  disciplinary  actions  as  are  prac- 
titioners in  North  Carolina  against  whom  the 
Board  can  and  does  proceed.  This  aspect 
of  the  problem  is  currently  receiving  study 
by  the  Board.  Until  the  question  is  resolved, 
it  is  believed  that  physicians  will  want  to 
keep  in  mind  the  dangers  associated  with 
the  mail  order  schemes,  and  to  advise  their 
patients  accordingly. 


The  therapist  should  be  a  good  listener.  Even  more  important,  he 
should  have  some  knowledge  of  semantics  and  should  reveal  to  the  pa- 
tient that  he  is  interested  in  what  the  patient  is  saying.  He  should  be- 
tray it  in  his  manner  and  his  personal  expression  as  well  as  in  what  he 
says  after  the  patient  has  expressed  his  opinion.  Remember  that  a  re- 
ceptive ear  receives  the  richest  harvest.  As  a  listener,  the  physician  in- 
creases his  knowledge  of  human  nature,  and  he  adds  to  his  own  store 
of  cultural  refinements.  He  will  find  that  in  enabling  his  patient  to  talk 
of  interests  other  than  personal  aches  and  worries,  he  has  effected  the 
best  therapv  possible. — Martin,  A.  R. :  Recreational  Measures  and  Their 
Value  to  Older  People,  J.  Am.  Geriatrics  Soc.  7:536   (July)    1959. 


September,  1960 


EDITORALS 


385 


North  Carolina  Medical  Journal 


Owned  and   published   by 

The  Medical  Society  of  the  State  of  North  Carolina, 

under  the  direction  of  its  Editorial  Board. 


EDITORIAL   BOARD 
Wingate  M.  Johnson,  M.D.,  Winston-Salem 

Editor 
Miss  Louise  MacMillan,  Winston-Salem 

Assistant   Editor 
Mr.  James  T.  Barnes,  Raleigh 

Business  Manager 
Ernest  W.   Furgurson,   M.D.,  Plymouth 
John  Borden  Graham,  M.D.,  Chapel   Hill 
G.  Westbrook  Murphy,  M.D.,  Asheville 
William   M.   Nicholson,   M.D.,   Durham 
Robert  W.  Prichard,  M.D.,  Winston-Salem 
Charles  W.  Styron,  M.D.,  Raleigh 

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NORTH  CAROLINA  MEDICAL  JOURNAL 
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September,  1960 

THE  NATIONAL  ELECTION 

Although  some  of  our  members  feel  that 
only  medical  subjects  should  be  discussed 
in  the  editorial  columns  of  this  journal,  the 
editorial  board  takes  the  broader  view  that 
doctors  need  to  be  well  rounded  citizens, 
and  that  the  inclusion  of  topics  of  a  gen- 
eral nature  makes  for  a  greater  appeal.  The 
widespread  interest  in  the  Democratic  and 
Republican  Conventions  justifies  the  as- 
sumption that  some  of  our  readers  would 
not  object  to  a  few  impressions  of  the  po- 
litical situation  from  a  viewpoint  as  inde- 
pendent and  unbiased  as  human  nature  will 
allow.  The  views  expressed  are  those  of  the 
editor  and  do  not  necessarily  reflect  the 
opinion  of  the  members  or  officials  of  the 
North  Carolina  Medical  Society. 

The  nomination  of  the  candidates  for  the 
presidency  was  for  each  party  a  foregone 
conclusion.  Both  successful  candidates  had 
paved  the  way  by  long  and  arduous  ground- 
work.   As  James   Reston   said    in   his   Neiv 


York  Times  column  for  July  31 :  "We  have 
two  efficiency  experts  as  presidential  can- 
didates." 

The  choices  for  the  vice  presidency,  how- 
ever, had  not  been  settled  in  advance  of  the 
political  conventions.  The  selection  of  Lyn- 
don Johnson  was  a  distinct  surprise  and 
somewhat  of  a  shock  to  many.  After  the 
caustic  comments  Kennedy  and  Johnson 
had  exchanged  before  the  convention,  John- 
son's selection  by  Kennedy,  and  his  ready 
acceptance,  proved  anew  that  politics  does 
indeed  make  strange  bedfellows. 

The  selection  of  Henry  Cabot  Lodge  was 
not  so  surprising.  His  yeoman  service  in 
the  United  Nations  has  made  him  a  recog- 
nized authority  on  our  foreign  relations. 
Parenthetically,  when  one  recalls  that  his 
grandfather  took  the  lead  in  sabotaging 
Woodrow  Wilson's  League  of  Nations,  the 
active  role  he  has  played  in  the  United  Na- 
tions illustrates  well  John  Charles  Mc- 
Neill's lines: 

How  teasing  truth  a  thousand  faces  claim, 

As  in  a  broken  mirror; 

And  what  a  father  died  for  in  the  flames, 

His  own  son  scorns  as  error. 

Just  as  Kennedy  subdued  his  personal 
feelings  toward  Johnson  in  order  to  win  his 
support,  Nixon  yielded  to  Nelson  Rocke- 
feller's demands  for  a  strong  civil  rights 
plank  in  the  Republican  Platform,  even  at 
the  cost  of  breaking  away  from  Eisen- 
hower's position  and  of  offending  the  South- 
ern delegates.  In  exchange,  Rockefeller 
agreed  to  give  up — for  the  time  at  least — 
his  own  presidential  ambitions  and  to  nom- 
inate Nixon,  even  though  he  could  not  re- 
member the  middle  initial. 

As  the  result  of  Mr.  Nixon's  need  to  pro- 
pitiate Mr.  Rockefeller,  the  platforms  of  the 
two  parties  do  not  offer  the  independent 
voter  too  much  choice — though  the  Demo- 
crats were  decidedly  more  lavish  with 
promises  than  the  Republicans.  As  Senator 
Ervin  was  quoted  as  saying,  however,  in  an 
effort  to  make  the  Southern  delegates  ac- 
cept the  civil  rights  plank,  "Platforms  are 
made  to  run  on,  not  to  stand  on." 

There  is  still  some  ground  for  the  opinion 
expressed  by  Dr.  John  K.  Glen  in  the  Texas 
State  Journal  of  Medicine  for  July,  1956 — 
that  non-voters  should  not  be  censured  for 
staying  away  from  the  polls,  because  there 
is  not  enough  difference   in  the   policies  of 


38ti 


NORTH    CAROLINA    MEDICAL   JOURNAL 


September,  1960 


the  two  major  parties  to  justify  the  trouble 
of  voting:  "Therefore,  a  host  of  conscien- 
tious non-voters  is  abuilding  and  becoming 
a  mighty  army.  Someone  has  said,  'What 
we  don't  need  in  the  United  States  is  a  third 
party.  What  we  do  need  is  a  second  party.'  ' 

And  a  recent  article  in  the  Saturday  Re- 
view by  Professor  and  Mrs.  Robert  Rienow 
asserts  that  many  non-voters  ai'e  so  indiffer- 
ent and  so  ignorant  of  political  affairs  that 
they  should  not  be  urged  to  vote.  At  least 
there  is  much  to  be  said  for  a  minimum  de- 
gree of  intelligence  as  a  requirement  for 
voting.  This  requirement  should,  of  course, 
be  applied  to  whites  as  well  as  to  non- 
whites. 

We  may  expect  the  hardest  fought  cam- 
paign since  Herbert  Hoover  defeated  Al 
Smith.  Both  candidates  have  expressed  will- 
ingness to  accept  the  offer  of  free  time  for 
joint  debate  made  by  the  major  broadcast- 
ing systems.  If  rightly  used,  these  debates 
should  stimulate  widespread  interest  in  the 
campaign. 

It  is  to  be  hoped  that  the  contest  will  not 
degenerate  into  a  mud-slinging  affair,  but 
that  each  candidate  may  take  the  high  road 
instead  of  the  low  one.  Both  men  are  high- 
ly intelligent  and  articulate  and  we  may  ex- 
pect each  one  to  present  his  case  forcefully. 
Let  us  hope  that  each  candidate  will  think 
in  terms  of  the  welfare  of  the  country  in- 
stead of  the  number  of  the  votes  he  can  win 
by  the  stand — or  stands — he  takes.  Let  us 
hope  also  that  citizens  will  decide  how  to 
vote  after  carefully  studying  the  merits  of 
each  candidate  and  the  vital  issues  ahead, 
and  may  the  number  of  independent  voters, 
and  of  the  really  conscientious  non-voters, 
continue  to  increase. 

*  ^  !;: 

SABIN   LIVE-VIRUS   POLIO 
VACCINE  APPROVED 

After  waiting  until  its  use  in  millions  of 
people  had  established  its  safety,  Surgeon 
General  Burney  has  approved  the  general 
use  of  the  Sabin  attenuated  live-virus  vac- 
cine. Two  other  live-virus  vaccines  have 
been  developed — one  by  Lederle's  Dr. 
Herald  R.  Cox,  the  other  by  Dr.  Hilary  Ko- 
prowski  of  the  Wistar  Institute  in  Phila- 
delphia. As  yet,  the  one  developed  by  Dr. 
Albert  B.  Sabin  of  Cincinnati  is  the  only 
one  approved. 

The  acceptance  of  a  live-virus  vaccine  for 
immunization  against  polio  is  good  news  for 
doctors,   parents,  and  children.   There  is  no 


doubt  but  that  the  live  virus  confers  a  more 
lasting,  perhaps  a  permanent,  immunity 
against  polio,  and  the  fact  that  it  is  taken 
by  mouth  in  a  pleasant  tasting  vehicle 
makes  it  far  more  acceptable  to  children, 
and  also  to  adults,  than  the  hypodermic 
needle  method. 

Although  the  Sabin  vaccine  has  been  ap- 
proved, it  will  be  some  time  yet  before  the 
manufacturers  have  produced  enough  to 
make  it  available  for  general  use,  and  it  is 
not  yet  certain  how  it  will  be  distributed. 
The  United  States  Public  Health  Committee 
on  Live-Virus  Vaccines  believes  that  the 
most  effective  way  to  eradicate  polio  would 
be  to  give  the  vaccine  in  mass  vaccination 
programs  rather  than  in  the  unsaturated 
contact  by  private  practitioners.  This 
method  was  used  in  Russia  and  other  for- 
eign countries  with  very  favorable  results 
reported.  The  committee  also  recommended 
that  the  vaccination  program  should  be 
continued  year  after  year. 

The  problem  of  finding  the  best  way  to 
distribute  the  live-virus  vaccine  will  re- 
quire cooperation  between  private  physi- 
cians and  the  Public  Health  worker.  It  does 
not  seem  too  much  to  hope  that  the  univer- 
sal use  of  this  type  of  vaccine  may  mean 
that  before  too  long  paralytic  polio  may  be 
as  rare  as  is  typhoid  now. 

ABOLISH  AGE  DISCRIMINATION 
IN  EMPLOYMENT? 

Senator  Pat  McNamara  deserves  com- 
mendation for  introducing,  on  June  22,  a 
bill  (S.3726)  to  abolish  age  discrimination 
in  employment  under  federal  contracts.  In 
introducing  the  bill.  Senator  McNamara 
said  in  part: 

We  have  listened  to  the  direct  testimony  of 
jobseekers  under  the  age  we  usually  think  of  as 
"old,''  and  have  studied  reports  about  discrim- 
ination in  employment  against  men  and  women 
of  40 — even  as  young  as  30  and  35  in  some 
cases  .  .  . 

We  have  adequate  scientific  evidence  now  that 
age  by  itself — especially  for  the  group  I  have 
reference  to,  under  65 — is  absolutely  no  basis 
for  deciding  whether  or  not  to  hire  a  new  worker 
or  replace  an  older  employee  .  .  . 

Even  in  times  of  full  employment — when  labor 
is  scarce — the  practice  of  age  discrimination  in 
employm3nt  exists   .   .   . 

It  is  more  and  more  important  that  we  broad- 
cast the  facts  about  the  argument  that  higher 
pension  costs  are  the  real  obstacle  to  hiring 
older  woi  kers.   The   Department   of  Labor's   stud- 


September,  1960 


EDITORALS 


387 


ies  of  this  type  of  argument  have  concluded  that 
such  costs  need  not  stand  in  the  way  of  a  sound 
policy  of  hiring-  on  the  basis  of  a  person's  actual 
ability  to  do  the  job — and  not  his  or  her  age. 

The  bill  I  am  introducing  (S.3726)— with  the 
co-sponsorship  of  Senators  Clark  and  Randolph — 
will  be  a  major  step  toward  reducing  this  shame- 
ful  and  unnecessary  practice. 

It  would  show  that  the  Government  itself  is 
practicing  what  it  preaches — by  requiring  that 
all  its  contracts  with  furnishers  of  goods  and 
services  adopt  personnel  policies  on  the  basis 
not  of  age — but  of  a  person's  actual  physical 
and  mental  abilities  to  perform  his  work — on  the 
basis  of  his  personal  merits — and  not  how  long- 
ago   he  was  born. 

This  bill  also  requires  that  the  Secretary  of 
Labor  organize  and  conduct  labor-management 
conferences  for  the  purpose  of  implementing-  and 
distributing  information  about  the  policy  of  the 
Act. 

S.3726,  if  passed,  should  do  much  to  en- 
courage the  continued  usefulness  and  self- 
respect  of  many  now  forbidden  gainful  em- 
ployment because  they  are  past  the  40-year 
mark. 

North  Carolina  has  been  a  pioneer  in 
crusading  for  fair  age-employment  policies. 
In  his  address  to  the  State  Conference  on 
Aging,  Governor  Hodges  made  a  vigorous 
protest  against  turning  people  out  to  pas- 
ture merely  because  they  have  reached  a 
certain  age.  And  long  before  that  he  had 
endorsed  a  brochure  entitled  "A  New  Look 
at  the  Mature  Worker,"  published  by  the 
Governor's  Coordinating  Committee  on  Ag- 
ing. This  brochure  anticipated  the  reason- 
ing of  Senator  McNamara's  bill. 


OCCUPATIONAL  HEALTH  ISSUE 

Industrial — or  occupational — health  has 
become  a  career  that  is  attracting  more  and 
more  physicians.  Next  month  North  Caro- 
lina will  for  the  first  time  be  host  to  the 
A.M. A.  Congress  on  Industrial  Health,  to 
be  held  in  Charlotte  October  1-12. 

In  anticipation  of  this  important  event 
this  issue  of  the  North  Carolina  Medical 
Journal  contains  a  collection  of  papers  on 
various  phases  of  occupational  health.  It 
will  be  noted  that  the  relation  of  the  pri- 
vate practitioner  to  this  special  field  is 
stressed.  These  papers  constitute  a  valuable 
source  of  information  on  an  increasingly 
important  subject. 


THE   SPEEDING   AMBULANCE 

A  number  of  editorials  have  been  written 
in  this  and  other  journals  on  the  menace  of 
the  speeding  ambulance.  A  recent  news 
story,  however,  of  an  ambulance  wrecked 
while  conveying  to  the  hospital  the  victim 
of  another  wreck  gives  an  occasion  for  one 
more  protest.  The  only  real  reason  for  an 
ambulance  to  speed  through  town  with  the 
siren  wide  open  and  flashing  red  lights  is 
the  advertising  feature.  Someone  has  said 
that  it  would  be  just  as  effective  advertis- 
ing and  safer  for  the  passenger  patients  if 
ambulances  were  equipped  with  sound  de- 
vices to  proclaim  at  frequent  intervals, 
"This  is  X's  ambulance!" 

It  is  pertinent  to  quote  again  from  an 
article  in  the  Journal  of  the  Michigan  State 
Medical  Society  (September,  1957)  by  Drs. 
George  J.  Curry  and  Sydney  N.  Lyttle :  "An 
ambulance  averaging  30  miles  per  hour 
would  require  10  minutes  to  travel  5  miles. 
To  save  5  minutes,  60  miles  per  hour  would 
be  necessary.  In  2,500  consecutive  ambu- 
lance runs,  this  time-interval  would  not 
have  influenced  the  course  of  a  single  in- 
jury." The  authors  added,  however,  that  36 
victims  were  in  severe  shock  upon  arrival 
at  the  hospital  and  that  "The  degree  of 
shock  may  have  been  increased  by  a  rough 
ride  in  an  ambulance." 

Is  it  not  time  for  some  legal  restrictions 
to  be  put  upon  the  ambulance? 


MAIL  ORDER  PRESCRIPTIONS 

At  the  Miami  Beach  Meeting  of  the 
A.M. A.  a  resolution  was  unanimously 
adopted  condemning  prescriptions  by  mail 
order  except  when  no  other  way  was  avail- 
able. In  this  issue  Mr.  H.  C.  McAllister, 
Secretary-Treasurer  of  the  North  Carolina 
Board  of  Pharmacy,  gives  clear-cut  and  log- 
ical arguments  against  the  prescription 
service  by  mail  now  being  offered  by  many 
out  of  state  concerns.  Every  doctor  should 
read  this  article  and  learn  from  it  how  to 
advise  his  patients  not  to  risk  their  health 
by  falling  for  the  lure  of  "price  discounts." 
The  doctor  and  the  pharmacist  should  work 
together  as  a  team  for  the  benefit  of  the 
patient — and  this  teamwork  is  not  possible 
when  the  pharmacist  is  far  off  in  another 
state. 


388 


NORTH    CAROLINA    MEDICAL  JOURNAL 


September,  19fi0 


President's  Message 


As  conscientious  and  ethical  American 
practitioners  of  medicine,  our  primary  mo- 
tivation must  always  be  to  initiate  and  sup- 
port those  qualities  of  medical  care  which 
are  productive  for  the  best  interests  of  the 
people  of  this  Nation.  However,  the  instinct 
of  self-preservation,  being  perhaps  the 
strongest  instinct  with  which  humans  are 
endowed,  motivates  us  as  physicians,  just 
as  other  organized  groups  in  society  are 
motivated,  to  advocate  and  support  those 
principles  which  are  favorable  to  the  pro- 
fession, provided  they  be  compatible  with 
the  best  interests  and  well-being  of  our  peo- 
ple. 

Controversy  relates  very  closely  to  moti- 
vation and  quite  often,  in  extremes,  pro- 
vides an  overflow  of  bitterness.  Currently, 
there  is  tremendous  awareness,  controver- 
sy, and  some  bitterness  concerned  with  the 
phenomenon  of  medical  care  within  our 
United  States.  Our  citizenry  is  currently  di- 
vided into  two  over-all  groups  who  have  a 
basic  divergence  of  opinion  as  to  what  is 
best  for  the  health  and  well-being  of  our 
people,  specifically  with  regard  to  the  pro- 
vision of  medical  care  on  a  national  level. 

On  the  one  side  are  those,  motivated  by 
socialistic  urges  and  political  expediency, 
who  advocate  medical  care  as  a  service  of 
the  Federal  Government.  This  group,  in  ef- 
fect, has  already  altered  our  Bill  of  Rights 
to  include,  in  addition  to  the  rights  to  "Life, 
Liberty,  and  the  Pursuit  of  Happiness,"  the 
right  to  share  the  national  wealth  by  tax- 
ation ;  the  right  of  labor  to  strike  and  bar- 
gain collectively;  Social  Security;  support 
and  regulation  for  agriculture  and  business. 
Now  these  people  would  add  the  right  to 
total  medical  care  as  a  function  and  service 
of  the  Federal  Government.  This  last  right 
is  to  be  furnished  regardless  of  the  indi- 
vidual's ability  or  desire  to  provide  such 
service  for  himself. 

All  physicians  hold  the  opinion  that 
everyone  is  entitled  to  medical  care.  We  be- 
lieve, however,  that  the  provision  of  this 
commodity,  in  its  entirety  for  all  people,  is 
not  rightfully  a  function  of  the  Federal 
Government.  In  accord  with  physicians  in 
this  belief  is  an  equally  large,  better  in- 
formed, and  better  educated,  properly  moti- 
vated segment  of  American  society.  This 
group  believes  and  can  document  the  fact 


that  socialized  medicine  is  synonymous  with 
inferior  medical  care  and  stagnation  of 
medical  progress  through  research.  It  is 
basic  that  a  competitive  spirit  is  yet  re- 
garded as  essential  to  the  vigor  and  quality 
of  medical  research  and  the  excellence  of 
medical  care,  because,  as  ever,  it  is  the 
principal  source  of  incentive  and  motiva- 
tion. 

Recently,  a  large  group  of  business,  farm, 
and  professional  people  in  this  country  pre- 
vailed upon  a  coalition  of  Northern  Repub- 
licans and  conservative  Southern  Democra- 
tic Senators  to  defeat  a  bill  before  the  Sen- 
ate designed  to  initiate  the  socialization  of 
medicine.  This  bill  embodied  the  principle 
of  government  relative  to  medical  care  as 
set  out  by  the  Platform  of  the  National 
Democratic  Party.  This  legislation  was  en- 
thusiastically supported  by  the  Democratic 
candidates  for  the  Presidency  and  Vice 
Presidency,  Senators  Kennedy  and  Johnson. 
More  adamant  in  support  of  this  legislation 
were  the  leaders  of  organized  labor  and 
labor  unions. 

Fortunately,  North  Carolina  has  in  its 
two  Senators  men  of  understanding  char- 
acter who  possess  the  ability  to  analyze  and 
understand  this  type  of  proposed  legisla- 
tion. Senators  Ervin  and  Jordan  are  also 
men  of  stability  and  conviction,  who  pos- 
sess the  fortitude  to  vote  their  sincere  con- 
victions regardless  of  party  affiliation.  Both 
of  our  Senators  strongly  advocated  the  de- 
feat of  this  bill  designed  to  provide  total 
Federal  medical  care  to  all  recipients  of 
Social  Security.  These  men  knew  this  bill 
for  what  it  was  and  recognized  that  it 
would  reflect  to  the  detriment  of  our  people. 

Senators  Jordan  and  Ervin  did  support 
and  help  pass  a  bill  which  meets,  head  on, 
the  problem  of  governmental  assistance  in 
the  provision  of  medical  care  for  the  needy 
and  near  needy.  Realistically,  this  bill, 
which  was  supported  by  medicine,  provides 
for  financial  participation  and  administra- 
tion at  state  and  local  levels. 

Physicians  as  a  group  or  as  individuals 
can  no  longer  afford  to  hold  aloof  from  the 
social,  economic,  or  political  facts  of  life. 
There  is  no  longer  room  in  medicine  for 
cynicism  and  indifference  as  applied  to  the 
basic  concepts  of  medicine  as  a  free  enter- 


September,  1960 


PRESIDENT'S  MESSAGE 


389 


prise  system  productive  of  the  best  medical 
care  known  to  the  world.  There  are  those 
prevalent  and  active  who  would  make  of 
our  profession  a  trade;  of  our  medical 
academies,  trade  schools ;  of  the  Federal 
Government,  our  employers,  and  of  our 
standards  of  excellence,  monotonous  medi- 
ocrity. Medicine  must  tighten  its  ranks  and 
protect  vigorously  those  things  which  we 
hold  to  be  inalienable  to  high  quality  med- 
ical care. 

May  I  urge  that  all  physicians  commence 
now  to  give  generously  of  themselves  as 
well  as  of  their  possessions  to  support  those 
in  government  and  politics  who  uphold  the 
principles  of  quality  medical  care  for  our 
people.  It  is  essential,  but  not  enough,  to 
give  your  money  to  support  our  friends  in 
government.  Giving  one's  self,  one's  time, 
one's  effort,  and  one's  personal  influence  is 
real  giving.  Medicine  has  the  potential.  No 
group  in  North  Carolina  has  the  personal 
contacts,  the  opportunity,  and  the  ability 
to  influence  the  thinking  of  our  people,  to 
the  well-being  of  all  concerned,  as  do  North 
Carolina's  physicians.  It  is  imperative  that 
we  take  a  few  minutes  each  day  with  each 
contact  to  exercise  this  prerogative. 

One  Southern  Senator,  name  unidentified, 
who  recently  supported  conservative  med- 
ical legislation  gave  as  his  reason  for  such 
action  the  fact  that  he  had  three  thousand 
doctors  in  his  state  on  his  side.  He  further 
stated  that  he  knew  of  no  other  group  of 
three  thousand  persons  whom  he  would 
rather  have  on  his  side.  There  is  reason  to 
believe  that  this  was  the  statement  of  a 
North  Carolina  Senator.  Let  us  not  let  him 
down. 

Amos  N.  Johnson,  M.D. 


BULLETIN  BOARD 


COMING  MEETINGS 

State 

Ninth  District  Medical  Society  Symposium — 
Moose  Lodge,  Morganton,  September  29. 

North  Carolina  Fifth  District  Medical  Society 
meeting — Mid   Pines    Club,    Pinehurst,   October    5. 

North  Carolina  Society  for  Crippled  Children 
and  Adults,  Twenty-fifth  Annual  Meeting — Wash- 
ington-Duke  Hotel,   Durham,    October   6-8. 

Eleventh  Annual  Winston-Salem  Heart  Sympo- 
sium— Robert  E.  Lee  Hotel,  Winston-Salem,  Octo- 
ber 7. 

North  Carolina  Board  of  Medical  Examiners,  in- 
terviews with  candidates  for  license  by  endorse- 
ment— Virginia  Dare  Hotel,  Elizabeth  City,  Octo- 
ber 7. 

Blue  Shield  Plans,  Annual  Program  Conference 
—Drake  Hotel,  Chicago,  October  10-11. 

A.M.A.'s  Twentieth  Annual  Conference  on  In- 
dustrial  Health— Charlotte,    October   10-12 

Seventh  District  Medical  Society,  Annual  Meet- 
ing— Gaston   Country   Club,   Gastonia,    October    19. 

Duke  University  Postgraduate  Medical  Seminar 
Cruise   to   the  West  Indies — November   9-18. 

Ninth  Annual  Gaston  Memorial  Hospital  Sym- 
posium— Masonic    Temple,    Gastonia,    November    17. 

North  Carolina  Academy  of  General  Practice, 
Annual  Meeting — Carolina  Hotel,  Pinehurst,  No- 
vember  27-30. 

Regional    and    National 

A.M.A.'s  First  Regional  Conference  on  Rural 
Health  (Southeastern  states) — Dinkier-Plaza  Hotel, 
Atlanta,   Georgia,   October  7-8. 

American  College  of  Surgeons,  Forty-sixth  An- 
nual Clinical  Congress — San  Francisco,  October 
10-14. 

American  Rhinologic  Society,  Sixth  Annual 
Meeting — Belmont   Hotel,   Chicago,   October   8. 


Winston-  Salem 


•••ia       D  Greensboro 

••  •        • 

•     *Q  Raleigh 


••• 


•  • 


••• 


MATERNAL   DEATHS    REPORTED  IN  NORTH  CAROLINA^ 
SINCE    JANUARY  I,   I960 

Each  dot  represents  one  death 


Washington,^       v£> 


*  r 

Wilmington,./ 


:!!iii 


NORTH   CAROLINA    MEDICAL  JOURNAL 


September,   1960 


American  Heart  Association,  Annual  Meeting — 
St.  Louis,  October  21-22. 

Southeastern  Allergy  Association,  Fifty-fourth 
Annual  Meeting — Atlanta  Biltmore  Hotel,  Atlanta, 
October  21-22. 

Southern  Chapter,  American  College  of  Chest 
Physicians,  Seventeenth  Annual  Meeting — Statler- 
Hilton  Hotel,  St.  Louis,  October  30-31. 

Southern  Medical  Association,  Annual  Meeting 
— St.   Louis,    October  31-November   3. 

Sixty-seventh  Annual  Convention  of  Military 
Surgeons — Washington,  D.  C,  October  31-Novem- 
ber 2. 

American  Medical  Writers'  Association — Morri- 
son Hotel,  Chicago,  November  18-19. 

Southeastern  Region  of  the  College  of  American 
Pathologists  and  the  Virginia  Society  of  Patholo- 
gists: Seminar  on  Kidney  Diseases — John  Marshall 
Hotel,    Richmond,    Virg-inia,    November   25-26. 

Emory  University  Postgraduate  Course  in  Oph- 
thalmic Surgery — Grady  Memorial  Hospital,  Atlan- 
ta, December  1-2. 


New  Members  of  the  State  Society 

The  following  physicians  joined  the  Medical  So- 
ciety of  the  State  of  North  Carolina  during  the 
month  of  August,  1960: 

Dr.  Claudia  Gertrude  Oxner,  St.  Joseph's  Hos- 
pital, Asheville;  Dr.  Luman  Harris  Tenney,  Route 
1,  Arden;  Dr.  John  Thomas  Dayton,  3800  N.  Inde- 
pendence Blvd.,  Charlotte  5;  Dr.  Charles  Otis 
Chrysler,  3800  N.  Independence  Blvd.,  Charlotte; 
Dr.  William  Joseph  Callison,  108  Doctors  Building, 
Asheville;  Dr.  Robert  Earl  Nolan,  O'Hanlon  Build- 
ing, Winston-Salem;  Dr.  Henning  Frederick 
Adickes,  Jr.,  2832  Selwyn  Avenue,  Charlotte;  Dr. 
Julian  Barker,  1012  Kings  Drive,  Charlotte;  Dr. 
Hugh  Harrison  Hayes,  Jr.,  3212  Country  Club 
Drive,  Charlotte;  Dr.  William  Malcolm  Eubanks, 
Jr.,  4200  Park  Road,  Charlotte;  Dr.  Cecil  Lawrence 
Johnston,   1616   Palm  St.,   Goldsboro. 


News  Notes  from  the  Bowman  Gray 
School  of  Medicine 

Dr.  Isadore  Meschan,  professor  of  radiology  and 
chairman  of  the  Department  of  Radiology,  has 
been  awarded  a  cancer  related  research  training 
grant  (radiation  biology)  by  the  National  Cancer 
Institute  of  the  National  Institutes  of  Health.  The 
grant  is  in  the  amount  of  $365,000  for  a  period  of 
three  years  and  nine  months. 

The  training  program  will  be  sponsored  through 
the  Department  of  Radiology,  and  will  be  under 
the  direction  of  Dr.  Donald  J.  Pizzarello.  The  pro- 
gram was  activated  on  September  1,  1960,  and  it 
is  anticipated  that  the  first  trainees  will  be  ap- 
pointed for  a  January  term. 

In  addition  to  his  duties  as  director  of  the  radi- 
ation biology  training  program,  Dr.  Pizzarello  will 
also  serve  as  a  member  of  the  teaching  staff.  He 
holds   the   bachelor  of   arts,   master    of   science    and 


doctor  of  philosophy  degrees  from  Fordham  Uni- 
versity, New  York  City.  For  the  past  year  he  has 
been  a  research  fellow  at  the  Argonne  National 
Laboratory,  Division  of  Biological  and  Medical  Re- 
search,  Argonne,    Illinois. 

In  addition,  14  research  grants  from  the  U.  S. 
Public  Health  Service,  totaling  $266,453  for  the 
coming  year,  were  awarded  to  the  Bowman  Gray 
School  of  Medicine  during  the  month  of  August. 
Among  the  largest  was  a  $50,000  award  to  Dr. 
Richard  L  Burt  for  "Studies  on  Carbohydrate 
Metabolism  in  Pregnancy"  and  $43,025  to  Dr.  Nor- 
man M.  Sulkin  for  "Ultrastructure  of  Nerve  Cells 
in  Experimental  Aging."  In  the  latter  grant,  funds 
are  approved  for  the  purchase  of  an  electron  micro- 
scope. Dr.  Robert  W.  Prichard  and  Dr.  Martin  G. 
Netsky  were  awarded  $29,440  for  "Studies  on 
Spontaneous  Atherosclerosis,"  and  Dr.  Harold  D. 
Green  received  approval  of  a  grant  for  "Inter-re- 
lation  of  Venous   Return   and   Vasomotor  Tone." 

*  #     * 

Dr.  Eben  Alexander,  Jr.,  professor  of  neurosur- 
gery, has  been  appointed  to  the  editorial  board  of 
the  Journal  of  Neurosurgery.  The  appointment  is 
effective  January   1,   1961. 

Dr.  Walter  J.  Bo,  a  native  of  Minnesota,  has 
joined  the  faculty  as  associate  professor  of  anato- 
my. Previously,  Dr.  Bo  was  associate  professor  of 
anatomy  at  the  University  of  North  Dakota  School 
of  Medicine  at  Grand  Forks,  North  Dakota. 

A  graduate  of  Marquette  University,  Dr.  Bo 
also  received  a  master  of  science  degree  in  zoology 
from  that  school.  He  holds  a  doctor  of  philosophy 
degree  from  the  University  of  Cincinnati  School 
of  Medicine  Graduate   School. 

He  has  been  an  instructor  in  zoology  at  Xavier 
University  at  Cincinnati,  a  teaching  fellow  in  his- 
tology at  the  University  of  Cincinnati,  a  cancer  re- 
search fellow  at  the  University  of  Cincinnati,  and 
assistant  professor  of  anatomy  at  the  University  of 
North   Dakota    Medical   School. 

*  *     * 

Dr.  Alanson  Hinman,  assistant  professor  of  pe- 
diatric enurology,  has  returned  from  a  three  year 
leave  of  absence.  During  his  leave,  Dr.  Hinman 
served  as  a  special  clinical  trainee  in  neurology  at 
Columbia  University,  College  of  Physicians  and 
Surgeons,   New  York   City. 

Dr.  Richard  C.  Proctor,  associate  professor  of 
psychiatry,  has  been  named  chairman  of  the  De- 
partment of  Psychiatry. 

Dr.  Angus  Randolph,  associate  professor  of  psy- 
chiatry, has  served  as  acting  chairman  of  the  de- 
partment since  1956.  He  will  continue  as  a  member 
of  the  full-time  faculty. 

Dr.  Proctor  graduated  from  Wake  Forest  Col- 
lege in  1942  and  from  Bowman  Gray  School  of 
Medicine  in  1945.  He  served  an  internship  and  resi- 
dency   at    the    U.     S.     Naval    Hospital,    Bremerton, 


September,  1960 


BULLETIN  BOARD 


391 


Washington;  the  N.  S.  Naval  Hospital,  Great 
Lakes,  Illinois;  and  at  Graylyn.  He  joined  the 
Bowman  Gray  faculty  in  July,  1950. 

He  has  served  as  secretary-treasurer  of  the 
Southern  Psychiatric  Association  and  president  of 
the  Day  Care  Nursing  Association.  He  is  a  mem- 
ber of  the  American  Psychiatric  Association,  the 
North  Carolina  Medical  Society,  the  Forsyth 
County  Medical  Society,  the  Southern  Medical  As- 
sociation, and  the  Tri-State  Medical   Society. 

From  1950  to  1952,  Dr.  Proctor  served  as  assist- 
ant director  of  Graylyn.  In  January,  1959,  he 
moved  his  office  from  Graylyn  to  the  Bowman 
Gray  School  of  Medicine,  where  he  continues  as  a 
full-time  member  of  the  faculty. 

Dr.  James  B.  Wray,  instructor  in  orthopaedics, 
will  assume  his  new  duties  as  chairman  of  the 
Section  on  Orthopaedics  at  the  State  Medical  Uni- 
versity of  New  York,  Upstate  Medical  Center,  Syr- 
acuse, New  York,  on  October  1,  1960. 

Dr.  Wray  has  served  as  a  member  of  the  Bow- 
man Gray  faculty  since  July,  1957. 


News  Notes  from  the  Duke  University 
Medical  Center 

As  announced  earlier,  the  Duke  University  Med- 
ical School  is  sponsoring  a  postgraduate  Medical 
Seminar  Cruise  to  the  West  Indies  this  fall  aboard 
the  new  Kungsholm,  Sweden's  largest  transatlantic 
liner  and  cruise  ship.  The  luxury  ship,  which  will 
sail  from  New  York  City  on  November  9,  will 
visit  the  Virgin  Islands  and  San  Juan,  Puerto  Rico, 
and  will  return  to   New  York  on  November   18. 

Shipboard  lectures  on  various  subjects  in  medi- 
cine, pediatrics  and  surgery  will  be  given  by  the 
following  members  of  the  Duke  Medical  School 
faculty:  Dr.  Edwin  P.  Alyea,  professor  of  urology; 
Dr.  Doris  Ahlee  Howell,  associate  professor  of 
pediatrics  and  pediatric  hematologist;  Dr.  William 
M.  Nicholson,  professor  of  medicine  and  assistant 
dean  for  Postgraduate  Medical  Education;  Dr.  El- 
bert L.  Persons,  professor  of  medicine;  and  Dr. 
William   M.   Shingleton,   professor  of   surgery. 

The  instructional  program  will  provide  20  hours 
credit  toward  postgraduate  requirements  of  the 
American  Academy  of  General  Practice.  While 
designed  primarily  for  the  generalist,  the  program 
should  be  of  value  and  interest  to  the  specialist. 
Informal  panel  discussions,  clinicopathologic  con- 
ferences, and  formal  presentations  will  be  given 
by  members  of  the  faculty. 

A  Duke  University  medical  scientists  is  ap- 
proaching the  study  of  strokes  through  observa- 
tion of  blood  vessels  inside  the  eyeball. 

Dr.  Albert  Heyman,  working  under  a  $2,000 
grant  from  the  Wilson  County  Heart  Association, 
is  utilizing  new  techniques  for  diagnosing  abnor- 
malities in  the  brain's  circulatory  system  and  also 
for    gaining    more    information    about    strokes.    He 


plans  to  study  the  retinal  blood  vessels  by  photo- 
graphing them  with  specially  adapted  "eye  ground" 
cameras,  by  making  motion  pictures,  and  by  meas- 
uring blood   pressure  inside   these  vessels. 

Dr.  Heyman  is  an  associate  professor  of  medicine 
at  the  Duke  Medical  Center.  Working-  with  him  in 
the  research  project  is  Dr.  Regina  Frayser,  in- 
structor in  medicine.  They  will  be  assisted  by 
photographers  in  the  medical  illustration  depart- 
ments of  Duke  Hospital  and  the  Veterans  Admin- 
istration   Hospital   here. 

A  new  radiation  therapy  and  research  division 
has  just  been  completed  at  the  Duke  University 
Medical  Center  and  is  now  in  use. 

Providing  extensive  facilities  for  radiation  treat- 
ment of  cancer,  the  division  is  housed  in  a  $375,000 
addition  to  Duke  Hospital  that  has  been  under 
construction  for  the  past  year. 

A  "cobalt  60"  therapy  unit,  one  of  several  in 
North  Carolina,  provides  radiation  dosage  equiva- 
lent to  that  of  a  three  million  volt  x-ray  machine 
for  treatment  of  deep-seated  cancer. 

A  "cesium  137"  unit  represents  the  latest  devel- 
opment in  supervoltage  radiation  therapy  equip- 
ment. Small  and  compact,  this  unit  produces  a 
beam  similar  in  many  ways  to  that  of  a  one  mil- 
lion volt  x-ray  machine  requiring  a  two-story  space 
for  installation.  The  cesium  unit  is  onn  of  a  few 
now  in  use  in  the  United  States. 

An  appointment  and  a  promotion  in  the  admin- 
istrative staff  of  Duke  Hospital  were  announced 
recently  by  Charles  H.  Frenzel,  hospital  superin- 
tendent. 

James  W.  Anderson  has  joined  the  staff  as  bus- 
iness  officer,    succeeding   Leonard   E.    Small. 

John  A.  Salmon,  Jr.,  has  been  promoted  from 
assistant  collections  officer  to  admitting  officer,  suc- 
ceeding Mrs.  Elizabeth  Hendricks. 

A  six-year  research  project  aimed  at  producing 
better  nurses  has  been  initiated  at  Duke  Univer- 
sity. The  study  is  being  conducted  jointly  by  the 
University's  Department  of  Sociology  and  Anthro- 
pology and  the  School  of  Nursing. 

Dr.  John  C.  McKinney,  sociology,  department 
chairman  and  principal  investigator  for  the  pro- 
ject, said  that  "in  effect,  we  are  studying  the  for- 
mation of  nursing  students'  professional  goals  and 
attitudes  during  the  course  of  their  education." 


News  Notes  from  the  University 
of  North  Carolina  School  of  Medicine 

North  Carolina  Memorial  Hospital  of  the  Uni- 
versity of  North  Carolina  received  its  one  hundred 
thousandth  patient  recently. 

The  number  100,000  was  marked  by  the  name  of 
Mrs.  Katie  B.  Koch  of  Bailey,  a  Nash  County  com- 
munity. Mrs.  Koch,  a  housewife,  was  treated  in  the 
Out-patient  Clinic  of  the  hospital. 

From  a  few  hundred  patients  seen  in  this  clinic 
the    year    the    hospital    opened — 1952 — the    number 


392 


NORTH   CAROLINA    MEDICAL  JOURNAL 


September,   I960 


during    the    past   12    months    has    grown    to    nearly 
60,000. 

The  hospital  observed  the  eighth  anniversary  of 
its  opening  on  September  2. 

*  *      * 

Dr.  Charles  H.  Burnett,  head  of  the  Department 
of  Medicine,  has  been  granted  a  year's  leave  of 
absence  for  research  work  at  the  University  of 
London.  During  his  absence,  the  department  will 
be  headed  by  Dr.  Louis  G.  Welt,  professor  of  medi- 
cine. 

Dr.  Robert  R.  Cadmus,  director,  and  E.  B.  Craw- 
ford, Jr.,  assistant  director  of  North  Carolina 
Memorial  Hospital,  flew  to  Panama  City,  Panama, 
recently  for  consultation  with  officials  of  a  new 
hospital  under   construction   there. 

Memorial  Hospital  has  had  a  contract  to  assist 
the  Panamanian  hospital  since  the  project  first  got 
underway  about  two  years  ago.  The  new  hospital 
is  expected  to  open  in  a  year. 

Experiments  have  been  conducted  with  a  new 
instrument  at  the  University  of  North  Carolina 
School  of  Medicine  which  has  successfully  meas- 
ured the  oxygen  in  the  brain   of  a  living  animal 

The  project  was  canned  out  by  three  anesthe- 
siologists of  the  Department  of  Surgery.  Dr.  Ken- 
neth Sugioka  was  the  principal  investigator.  He 
was  assisted  by  Drs.  David  Davis  and  Rodney  Mc- 
Knight, 

An  account  of  this  research  was  given  August 
24  at  the  Stanford  University  Medical  Center  at 
Palo  Alto,  California,  before  the  annual  meeting 
of   the   American  Physiological    Society. 

Prior  to  the  development  of  this  instrument, 
exact  measurement  of  oxygen  in  tissue  had  not 
been  possible. 

Dr.  Charles  E.  Flowers,  Jr.,  associate  professor 
of  obstetrics  and  gynecology,  went  to  the  Univer- 
sity of  California  recently  to  establish  a  special 
study  of  "Diabetes  in  Pregnancy"  for  the  Ameri- 
can Medical  Association. 

*  *     * 

A  $2  million  request  to  help  launch  construction 
of  a  long  range  health  center  addition  at  North 
Carolina  Memorial  Hospital  was  included  in  the 
university's  $15.3  million  capital  improvements 
budget  request  presented  recently  to  the  state's 
Advisory  Budget  Commission. 

Also  included  in  the  total  $3,459,000  budget  re- 
quest for  the  Division  of  Health  Affairs  for  the 
coming  biennium  is  a  $1,434,000  appropriation  to 
provide  complete  air  conditioning  for  Memorial 
Hospital  and  the  School  of  Dentistry.  Another 
$25,000  is  earmarked  for  renovation  of  certain 
areas  in  the  medical  school. 

The  health  center  addition  would  be  the  first 
stage  in  a  10-year  physical  expansion  program 
which  might  cost  upwards  of  $8  million. 


The  University  of  North  Carolina  is  getting  a 
$30,000  gift  from  the  will  of  Mrs.  Elva  Bryan  Mc- 
Iver  of  Sanford. 

The  Council  of  State  has  formally  accepted  a  47- 
acre  tract  of  land  valued  at  $30,000  which  Mrs. 
Mclver  willed  to  be  used  to  establish  a  loan  fund 
for  medical  students  at  the  university. 

The    gift  was    left   in   memory   of    Mrs.    Mclver's 

husband,  the  late  Dr.  Lynn   Mclver. 

*     *      * 

A  new  training  program  for  persons  engaged  in 
the  care  of  the  mentally  ill  is  being  organized  by 
the  North  Carolina  State  Hospitals  Board  of  Con- 
trol. 

Dr.  Charles  R.  Vernon  of  the  Department  of 
Psychiatry,  U.N.C.  School  of  Medicine,  has  been 
named   director. 

Dr.  Kendall  Owen  Smith,  who  has  made  signifi- 
cant contributions  to  the  knowledge  of  how  vir- 
uses invade  living  tissue  cells  in  research  utilizing 
an  electron  microscope  at  the  U.N.C.  School  of 
Medicine,  has  accepted  a  position  at  Baylor  Uni- 
versity in   Houston,  Texas. 

Dr.  Smith,  a  Ph.D.  graduate  in  bacteriology  in 
the  U.N.C.  medical  school  and  a  native  of  Wilson, 
has  been  since  August,  1959,  a  postdoctorate  train- 
ee of  the  U.  S.  Public  Health  Service,  working 
with  Dr.  Gordon  Sharp  in  the  newly  established 
biophysics  laboratory  in  the  School  of  Medicine 
here.  Dr.  Smith  has  worked  with  Dr.  Sharp  in  ex- 
periments using  the   electron  microscope. 

At  Baylor  University,  Dr.  Smith  will  work  with 
Dr.  Joseph  Melnik,  and  continuation  of  experi- 
ments begun  at  Chapel   Hill  will  be  possible. 

:Jc  >»-.  :;: 

Dr.  Richard  Dobson,  head  of  the  Division  of  Der- 
matology, spoke  recently  before  the  first  Interna- 
tional Congress  of  Histochemistry  in  Paris,  France, 
on  the  subject  of  "The  Histochemistry  of  the  Hu- 
man Sweat  Gland." 

Dr.  Dobson  is  engaged  in  various  studies  of  the 
skin  and  the  sweat  glands. 


Eleventh  Annual  Winston-Salem 
Heart  Symposium 

The  eleventh   annual   Winston-Salem   Heart   Sym- 
posium will  be  held  at  the  Robert  E.  Lee  Hotel  in 
Winston-Salem  on  October  7.  The  program  follows. 
Morning 
9:30-10:25     Presiding:    Robert    L.    McMillan,    M.D. 
Governor,    North    Carolina    American 
College   of   Physicians,   Winston-Salem 
"Recent   Advances   In   Experimental 
Atherosclerosis" 

Thomas  H.   Clarkson,  D.  V.   M.,  Win- 
ston-Salem 
10:25-11:15     "Human   Atherosclerosis    and    Lipid 
Metabolism:    Current  Concepts" 
Donald    Fredrickson,    M.D.,    Bethesda, 
Maryland 


September,  1960 


BULLETIN   BOARD 


393 


11:30  A.M.-1:00  P.M.  Panel 

"Clinical    Management   of  Athero- 
sclerosis" 

Diet,    Cholestorol-lowering    Drugs, 
Anti-coagulant,    Surgery 
Moderator:      Robert   W.    Priehard,    M.D.,    Winston- 
Salem 
Participants:   Edward   S.    Orgain,    M.D.,    Durham 
Henry  T.    Bahnson,   M.D.,    Baltimore, 
Maryland 

Donald    Fredrickson,    M.D.,    Bethesda, 
Maryland 
1:00  P.M.  Lunch 

Afternoon 

2:00-  2:50     Presiding:    Charles    R.    Welfare,    M.D., 
Winston-Salem,    President,    Forsyth 
County  Medical   Society 
"Treatment   of   Hypertensive  Vascular 
Disease" 
Edward    S.    Orgain,   M.D.,   Durham 

2:50-  3:40     "Surgical   Management   of   Vascular 
Occlusive    Disease"    With    Special 
Comments  on  Treatment  of  Carotid 
Obstructive   Syndromes. 
Henry  T.   Bahnson,   M.D. 

3:50-  4:40     "External    Cardiac    Resuscitation" 

A   New  Technique   of  Cardiac  Massage 
Without  Opening  the  Chest. 
James  R.   Jude,   M.D.,   Baltimore, 
Maryland 

4;: 40-  5:40  P.M.  Clinico-Pathological    Conference 
Edward  S.   Orgain,  M.D. 

6:00-  7:00  Social  Hour 

7:00  Dinner 

Presiding:   Mr.  James   A.   Way, 
President,   Forsyth   County   Heart 
Association,    Winston-Salem 
Speaker:   Dr.   Mark  Depp,  Pastor, 
Centenary  Methodist  Church, 
Winston-Salem 

Introductions:  Benjamin  F.  Huntley, 
M.D.,  Chairman,  Heart  Symposium, 
Winston-Salem 


Seminar  on  Athletic  Injuries 

The  University  of  North  Carolina  School  of 
Medicine,  in  cooperation  with  the  North  Carolina 
High  School  Athletic  Association  and  the  North 
Carolina  Committee  on  Trauma  of  the  American 
College  of  Surgeons,  co-sponsored  a  one-day  sem- 
inar on  "The  Prevention  and  Management  of 
Athletic  Injuries"  at  North  Carolina  Memorial 
Hospital  on  September  21. 

Guest  member  of  the  seminar  faculty  was  Dr. 
Charles  J.  Frankel  of  the  Department  of  Ortho- 
pedic Surgery  and  athletic  team  physician  of  the 
University  of  Viriginia.  Dr.  William  P.  Richard- 
son, assistant  dean  for  continuation  education  pre- 
sided. -  ■■■'_■ 


North  Carolina  Heart  Association 

Dr.  Eugene  A.  Stead,  Jr.,  professor  and  chair- 
man of  Medicine  at  Duke,  will  deliver  the  Lewis  A. 
Conner  Memorial  Lecture  at  the  opening  Scientific 
Session  of  the  American  Heart  Association's  an- 
nual meeting  in  St.  Louis  on  October  21.  His  topic- 
is  "Physiology  of  the  Circulation  as  Viewed  by  the 
Internist."  The  remainder  of  this  session  will  be 
conducted  jointly  by  the  American  Heart  Council 
on  Clinical  Cardiology  and  the  American  College 
of  Cardiology. 

Forms  for  registering  for  attendance  may  now 
be  obtained  from  the  North  Carolina  Heart  Asso- 
ciation,  Miller  Hall,    Chapel   Hill,   North    Carolina. 


North  Carolina  Board  of 
Medical  Examiners 

The  North  Carolina  State  Board  of  Medical  Ex- 
aminers will  meet  at  the  Virginia  Dare  Hotel,  Eliz- 
abeth City,  on  October  7,  to  interview  applicants 
for   license   by  endorsement. 


Ninth  District  Medical  Society 
Symposium 

The  annual  Ninth  District  Medical  Society  Sym- 
posium will  be  held  at  Moose  Lodge  in  Morganton 
on   September  29. 

Officers  of  the  Ninth  District  Society  are:  pres- 
ident— Dr.  G.  M.  Billings;  vice  president,  Dr.  J.  B. 
Helms;  secretary-treasurer,  Dr.  L.  B.  Snow. 

For  further  information,  write,  Dr.  L.  B.  Snow, 
Drawer  150,   Morganton,   North   Carolina. 


Edgecombe-Nash  Medical  Society 

The  Edgecombe-Nash  Medical  Society  held  its 
monthly  meeting  in  Rocky  Mount  on  August  10. 
Dr.  Raymond  Adams  of  the  Department  of  Neur- 
ology, Medical  College  of  Virginia,  was  guest 
speaker. 


News  Notes 

Drs.     Hall,     Lafferty,     Coppedge,     Burnett,     and 

Roth   of   Charlotte   have   announced   the    association 

of    Dr.    Hugh    Harrison    Hayes,    Diplomat    of    the 

American    Board    of    Radiology,   in    the    practice    of 

radiology. 

*     *     * 

Drs.  Paul  W.  Sanger  and  Frederick  H.  Taylor 
of  Charlotte  announce  the  association  of  Dr.  Fran- 
cis Robicsek  in  the  practice  of  cardiovascular  and 
thoracic   surgery. 


Southeastern  Rural  Health  Conference 

Physicians  and  farm  group  representatives  from 
11  Southeastern  states  will  gather  in  Atlanta, 
October  7-8,  for  the  first  regional  conference  on 
rural  health. 

"Joining  Hands  for  Community  Health"  is  the 
theme  of  the  meeting,  which  will  be  held  at  the 
Dinkier     Pla